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Septic shock in a cohort of patients from the northeast of France: a preliminary epidemiological study, EPISS group
© Quenot et al. 2011
- Published: 1 March 2011
- Septic Shock
- Metabolic Acidosis
- Observational Cohort Study
- Intensive Care Patient
- Survive Sepsis Campaign
Incidence of septic shock in France ranges from 8 to 10% among patients admitted to intensive care. Mortality at 28 days is 55 to 60% . We aimed to investigate epidemiology, treatment and mortality of patients with septic shock further to the Surviving Sepsis Campaign international guidelines .
A prospective, multicentre, observational cohort study supported by the Collège Interrégional des Réanimateurs du Nord-Est (CIRNE) including 14 ICUs in 10 university or nonacademic hospitals. Inclusion criteria were: patients presenting with documented/suspected infection requiring initiation of vasopressor amines despite adequate vascular filling, with at least one of the following hypoperfusion criteria: metabolic acidosis (base excess ≥5 mEq/l or alkaline reserve <18 mEq/l or lactate ≥2.5 mmol/l); oliguria/renal insuf-ficiency (< 0.5 ml/kg/hour for 3 hours or elevation >50% of baseline creatinine); or hepatic dysfunction (AST or ALT >500 IU/l or bilirubin >20 mg/l (34 μmol/l)). Quality control was performed by the Dijon Clinical Investigation Center (INSERM).
Mean inclusion was 80 patients/month for all centres. We analysed the first 350 patients with validated files of 876 patients included up to 1 December 2010. Mean age was 69 ± 13 years, 66% men. Indication for admission was medical in 84%. Mean SAPS II score was 60.9 ± 21.8, mean SOFA score at time of shock was 11.7 ± 3.5. Sepsis was mainly of pulmonary (45.7%), digestive (19.4%), or urinary (11.1%) origin, with 23.8% other causes. Sepsis was mainly community-acquired (63.7%) and was documented in 67% (234/350), of which 53.4% were Gram-negative bacilli, 30.3% Gram-positive cocci and 16.3% others. Replacement techniques used were: invasive mechanical ventilation (82.6%), continuous dialysis (31.1%) and discontinuous dialysis (19.7%). Activated protein C was used in 17 patients (5%) and hydrocortisone hemisuccinate in 238 (68.6%). Mortality was 49.1% in intensive care, 58.8% in-hospital.
Our findings raise hope of improved knowledge of epidemiology and management of septic shock in intensive care patients, and should have a beneficial effect on prognosis.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.