Huang Chun-Ta, Tsai Yi-Ju, Tsai Pi-Ru, Yu Chong-Jen, Ko Wen-Je
*Department of Traumatology, National Taiwan University Hospital †Department of Internal Medicine, National Taiwan University Hospital ‡Graduate Institute of Clinical Medicine, National Taiwan University §Graduate Institute of Basic Medicine and School of Medicine, College of Medicine, Fu Jen Catholic University ¶Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Shock. 2016 May;45(5):518-24. doi: 10.1097/SHK.0000000000000540.
Timing of septic shock onset may play a prognostic role in severe sepsis; however, clinical evidence provides contradictory results. This study aimed to investigate possible associations between timing of onset of septic shock and patient outcome.
In a university-affiliated hospital, all patients admitted to the intensive care unit (ICU) for severe sepsis or septic shock from November 2007 to March 2011 were included. The primary outcome of interest was the impact of timing of septic shock onset on in-hospital mortality. We also sought to identify potential factors predicting development of septic shock after ICU admission.
In total, 772 patients were identified to have severe sepsis; approximately two-thirds (487/772) of them experienced septic shock and overall in-hospital mortality was 57%. Timing of onset of septic shock was an independent predictor of in-hospital outcome, and there was an increasing trend of in-hospital mortality with later onset of septic shock. In addition, timing of septic shock onset provided further mortality risk stratification in patients with APACHE II scores of less than 20 and 20 to 25. We also found that patients who underwent cardiovascular surgery were more likely to experience septic shock after admission and those receiving neurosurgery were at lower risk of developing septic shock.
This study showed the significance of timing of septic shock onset in prognosis among ICU patients with severe sepsis. Timing of shock onset further stratified patients with similar disease severity into different mortality risk groups. These findings deliver useful information regarding risk stratification of septic patients.
脓毒性休克发作的时间可能在严重脓毒症中发挥预后作用；然而，临床证据提供了相互矛盾的结果。本研究旨在调查脓毒性休克发作时间与患者预后之间可能存在的关联。
在一家大学附属医院，纳入了2007年11月至2011年3月期间因严重脓毒症或脓毒性休克入住重症监护病房（ICU）的所有患者。主要关注的结果是脓毒性休克发作时间对住院死亡率的影响。我们还试图确定预测ICU入院后发生脓毒性休克的潜在因素。
总共确定了772例患有严重脓毒症的患者；其中约三分之二（487/772）经历了脓毒性休克，总体住院死亡率为57%。脓毒性休克发作时间是住院结局的独立预测因素，且随着脓毒性休克发作时间的延迟，住院死亡率呈上升趋势。此外，脓毒性休克发作时间在急性生理学与慢性健康状况评分系统II（APACHE II）评分小于20分以及20至25分的患者中提供了进一步的死亡风险分层。我们还发现，接受心血管手术的患者入院后更有可能发生脓毒性休克，而接受神经外科手术的患者发生脓毒性休克的风险较低。
本研究表明脓毒性休克发作时间在患有严重脓毒症的ICU患者预后中的重要性。休克发作时间进一步将疾病严重程度相似的患者分为不同的死亡风险组。这些发现为脓毒症患者的风险分层提供了有用信息。
