Mortality rate of vasopressor-dependent septic shock from 1997 through 2006

Introduction

Recently introduced interventions including early goal-directed therapy (EGDT) improve the mortality of severe sepsis/septic shock. We undertook this study to describe the trend in the mortality rate of vasopressor-dependent septic shock over a 10 year-period.

Methods

We used the APACHE III database of our institution to identify patients with septic shock. Patients with an ICU admission diagnosis of infection and who were on a vasopressor on the first ICU day were considered to have vasopressor-dependent septic shock. We divided the study period into pre-EGDT (1997 to 2000), transit (2001, 2002), and post-EGDT (2003 to 2006). We calculated the standardized mortality ratio (SMR) with the 95% confidence interval.

Results

Of 53,096 admissions, 4,981 (9.4%) had a diagnosis of infection. The hospital mortality rates of the patients with and without infection were 21.2% and 9.3%, respectively (P < 0.001). Vasopressor was infused in 1,340 (26.9%) of the patients with infection. The hospital mortality rate of the vasopressor-receiving patients with infection was 32.4% compared with 17.1% of those who did not receive vasopressor (P < 0.001). The SMR of the vasopressor-dependent septic patients was lowest during the post-EGDT period (Table 1).

Table 1 Mortality of vasopressor-dependent septic shock during the study period

Conclusion

The hospital mortality rate of patients admitted to the ICU for infection is higher than that of patients admitted for other reasons. The hospital survival rate of patients with vasopressor-dependent septic shock has improved in the post-EGDT era.