Yang Won S, Kang Hui D, Jung Sang K, Lee You J, Oh Se H, Kim Youn-Jung, Sohn Chang H, Kim Won Y
Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Respir J. 2020 Sep;14(9):857-863. doi: 10.1111/crj.13218. Epub 2020 Jun 8.
This study aimed to compare the 28-day mortality of patients with septic shock, defined by Sepsis-3 criteria and patients with vasoplegic or cryptic shock who are excluded from this new definition.
This retrospective observational study was performed using a tertiary emergency department's septic shock registry and investigated the records of patients managed between January 2010 and December 2015. In 2,138 total patients, 1004 (47.0%) had septic shock, 476 (22.2%) had vasoplegic shock and 655 (30.6%) had cryptic shock.
There was significant variation in 28-day mortality among the three groups: 23.4% for septic shock, 8.8% for vasoplegic shock and 12.2% for cryptic shock (P < .001). In subgroup analysis of cryptic shock or septic shock according to lactate levels (2-3, 3-4 and >4 mmol/L), the mortality rate increased as lactate increased (cryptic shock: 9.5%, 14.8% and 18.0%; septic shock: 18.6%, 22.6% and 27.0%, respectively; P < .001). Multivariable analysis revealed odds ratios for mortality of 0.31 (95% CI 0.22-0.44; P < .001) for vasoplegic shock and 0.46 (95% CI 0.35-0.61; P < .001) for cryptic shock relative to septic shock. Survival curve analysis showed significant differences among patients with septic shock, vasoplegic shock and cryptic shock (Log rank test: P < .0001).
The new septic shock definition may be useful for identifying high-risk patients requiring intensive care. However, cryptic shock-associated mortality increased to 18.0% as serum lactate increased, which suggests that some cryptic shock patients may also require intensive management.
本研究旨在比较根据脓毒症-3标准定义的感染性休克患者与被排除在这一新定义之外的血管麻痹性休克或隐匿性休克患者的28天死亡率。
本回顾性观察研究使用了一家三级急诊科的感染性休克登记处，并调查了2010年1月至2015年12月期间接受治疗的患者记录。在总共2138例患者中，1004例（47.0%）患有感染性休克，476例（22.2%）患有血管麻痹性休克，655例（30.6%）患有隐匿性休克。
三组患者的28天死亡率存在显著差异：感染性休克为23.4%，血管麻痹性休克为8.8%，隐匿性休克为12.2%（P <.001）。在根据乳酸水平（2 - 3、3 - 4和>4 mmol/L）对隐匿性休克或感染性休克进行的亚组分析中，死亡率随着乳酸水平的升高而增加（隐匿性休克：分别为9.5%、14.8%和18.0%；感染性休克：分别为18.6%、22.6%和27.0%；P <.001）。多变量分析显示，相对于感染性休克，血管麻痹性休克的死亡比值比为0.31（95%置信区间0.22 - 0.44；P <.001），隐匿性休克为0.46（95%置信区间0.35 - 0.61；P <.001）。生存曲线分析显示，感染性休克、血管麻痹性休克和隐匿性休克患者之间存在显著差异（对数秩检验：P <.0001）。
新的感染性休克定义可能有助于识别需要重症监护的高危患者。然而，随着血清乳酸水平升高，隐匿性休克相关死亡率增至18.0%，这表明一些隐匿性休克患者可能也需要强化治疗。
