Which risk factors are associated with increased mortality rates in sepsis and septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

In one epidemiologic study, reported mortality figures were 7% for SIRS, 16% for sepsis, 20% for severe sepsis, and 46% for septic shock. [49] Poor prognostic factors included the following:

  • Advanced age

  • Infection with a resistant organism

  • Impaired host immune status

  • Poor prior functional status

  • Continued need for vasopressors past 24 hours

  • Development of sequential organ failure, despite adequate supportive measures and antimicrobial therapy

A link between impaired adrenal function and higher septic shock mortality has been suggested. The adrenal gland is enlarged in these patients as compared with control subjects. A study by Jung et al found that the absence of this enlargement, indicated by total adrenal volume of less than 10 cm3, was associated with increased 28-day mortality in patients with septic shock. [50]

A multicenter prospective study published by Brun-Buisson et al reported a mortality of 56% during ICU stays and 59% during hospital stays, [3] with 27% of all deaths occurring within 2 days of the onset of severe sepsis and 77% occurring within the first 14 days. The risk factors for early mortality in this study were as follows:

  • Higher severity of illness score

  • Acute failure of 2 or more organ systems at the time of sepsis

  • Shock

  • Low blood pH (<7.3)

Studies have shown that appropriate selection and early administration of antibiotics (ie, antibiotics that are effective against the organism that is ultimately identified) lead to a significant reduction in mortality. [51] For this reason, it is important to initiate broad-spectrum coverage until the specific organism is cultured and antibiotic sensitivities are determined.


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