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Vol. 45. Issue 9.
Pages 541-551 (December 2021)
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Vol. 45. Issue 9.
Pages 541-551 (December 2021)
Original
Clinical risk factors for early mortality in patients with community-acquired septic shock. The importance of adequate source control
Factores de riesgo clínico asociados a mortalidad precoz en pacientes con shock séptico de origen comunitario. La importancia de un control del foco adecuado
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J. Vallés
Corresponding author
jvalles1953@hotmail.com

Corresponding author.
, E. Diaz, J. Carles Oliva, M. Martínez, A. Navas, J. Mesquida, G. Gruartmoner, C. de Haro, J. Mestre, C. Guía, A. Rodriguez, A. Ochagavía
Critical Care Department, Fundació Parc Taulí, Hospital Universitari Parc Taulí, Sabadell, Spain
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Figures (2)
Tables (5)
Table 1. Characteristics of patients with early mortality and survivors more than 72h.
Table 2. Source of infection and pathogens isolated in patients with early mortality and survivors more than 72hours.
Table 3. Patients with early mortality (≤72h) (n:90).
Table 4. Patients survivors>72h (n:535).
Table 5. Multivariate analysis for independent factors associated with death within 72h of ICU admission.
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Abstract
Objective

To evaluate the incidence and risk factors for early mortality (EM) in the ICU in patients with community-acquired septic shock (CASS).

Design

A retrospective cohort study of patients with CASS admitted to the ICU (2003–2016).

Setting

ICU at a University Hospital in Spain.

Patients

All consecutive patients admitted to the ICU with CASS.

Interventions

None.

Main variables of interest

CASS was defined according to the Sepsis-3 definitions. EM were defined as occurring within of 72h following ICU admission. A multinomial logistic regression analysis was performed to identify the risk factors associated with early deaths.

Results

During the study period, 625 patients met the Sepsis-3 criteria and admitted with CASS. 14.4% of all patients died within the first 72h. Of 161 patients who died in the ICU, 90 (55.9%) died within the first 72h. The percentage of early and late mortality did not vary significantly during the study period. The need and adequacy of source control were significantly lower in patients with EM. In the multivariate analysis, ARDS, non-respiratory infections, bacteremia and severity at admission were variables independently associated with EM. The only factor that decreased EM was adequate source control in patients with infections amenable to source control.

Conclusions

The incidence of EM has remained stable over time, which means that more than half of the patients who die from CASS do so within the first 72h. Infections where adequate source control can be performed have lower EM.

Keywords:
Community-acquired infections
Septic shock
ICU
Early mortality
Source control
Resumen
Objetivo

Evaluar la incidencia y los factores de riesgo de mortalidad precoz (MP) en la UCI en pacientes con shock séptico adquirido en la comunidad (SSAC).

Diseño

Estudio de cohorte retrospectivo de pacientes con SSAC ingresados en la UCI (2003-2016).

Lugar

La UCI de un hospital universitario en España.

Pacientes

Todos los pacientes consecutivos ingresados en la UCI por SSAC.

Intervenciones

Ninguna.

Principales variables de interés

El SSAC se definió según los criterios de Sepsis-3. Una MP se consideró la que ocurría dentro de las 72h posteriores a la admisión en la UCI. Se realizó un análisis de regresión logística multinomial para identificar los factores de riesgo asociados con MP.

Resultados

Durante el período de estudio, 625 pacientes cumplieron los criterios de Sepsis-3 e ingresaron por SSAC. El 14,4% de los pacientes fallecieron en las primeras 72h. De los 161 pacientes que fallecieron en la UCI, 90 (55,9%) lo hicieron dentro de las primeras 72h. El porcentaje de mortalidad precoz y tardía no varió significativamente durante el período de estudio. La necesidad y la eficacia del control del foco de sepsis fueron significativamente menores en los pacientes con MP. En el análisis multivariado, el SDRA, las infecciones no respiratorias, la bacteriemia y la gravedad al ingreso fueron variables asociadas independientemente con una MP. El único factor que disminuyó la MP fue un control del foco de sepsis adecuado en aquellos pacientes con infecciones susceptibles de precisar un control del foco.

Conclusiones

La incidencia de MP se ha mantenido estable en el tiempo, lo que significa que más de la mitad de los pacientes que mueren por SSAC lo hacen dentro de las primeras 72h. Las infecciones donde se puede realizar un control adecuado del foco tienen una MP inferior.

Palabras clave:
Infecciones adquiridas en la comunidad
Shock séptico
UCI
Mortalidad precoz
Control del foco

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