title: The epidemiology of septic shock in French intensive care units: the prospective multicenter cohort EPISS study.
abstract: BACKGROUND
  To provide up-to-date information on the prognostic factors associated with 28-day mortality in a cohort of septic shock patients in intensive care units (ICUs).
  
  
  METHODS
  Prospective, multicenter, observational cohort study in ICUs from 14 French general (non-academic) and university teaching hospitals. All consecutive patients with septic shock admitted between November 2009 and March 2011 were eligible for inclusion. We prospectively recorded data regarding patient characteristics, infection, severity of illness, life support therapy, and discharge.
  
  
  RESULTS
  Among 10,941 patients admitted to participating ICUs between October 2009 and September 2011, 1,495 (13.7%) patients presented inclusion criteria for septic shock and were included. Invasive mechanical ventilation was needed in 83.9% (n=1248), inotropes in 27.7% (n=412), continuous renal replacement therapy in 32.5% (n=484), and hemodialysis in 19.6% (n=291). Mortality at 28 days was 42% (n=625). Variables associated with time to mortality, right-censored at day 28: age (for each additional 10 years) (hazard ratio (HR)=1.29; 95% confidence interval (CI): 1.20-1.38), immunosuppression (HR=1.63; 95%CI: 1.37-1.96), Knaus class C/D score versus class A/B score (HR=1.36; 95%CI:1.14-1.62) and Sepsis-related Organ Failure Assessment (SOFA) score (HR=1.24 for each additional point; 95%CI: 1.21-1.27). Patients with septic shock and renal/urinary tract infection had a significantly longer time to mortality (HR=0.56; 95%CI: 0.42-0.75).
  
  
  CONCLUSIONS
  Our observational data of consecutive patients from real-life practice confirm that septic shock is common and carries high mortality in general ICU populations. Our results are in contrast with the clinical trial setting, and could be useful for healthcare planning and clinical study design.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
authors.forename: Christine
authors.initials: C
authors.lastname: Binquet
authors.forename: Fady
authors.initials: F
authors.lastname: Kara
authors.forename: Olivier
authors.initials: O
authors.lastname: Martinet
authors.forename: Frederique
authors.initials: F
authors.lastname: Ganster
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Navellou
authors.forename: Vincent
authors.initials: V
authors.lastname: Castelain
authors.forename: Damien
authors.initials: D
authors.lastname: Barraud
authors.forename: Joel
authors.initials: J
authors.lastname: Cousson
authors.forename: Guillaume
authors.initials: G
authors.lastname: Louis
authors.forename: Pierre
authors.initials: P
authors.lastname: Perez
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Kuteifan
authors.forename: Alain
authors.initials: A
authors.lastname: Noirot
authors.forename: Julio
authors.initials: J
authors.lastname: Badie
authors.forename: Chaouki
authors.initials: C
authors.lastname: Mezher
authors.forename: Henry
authors.initials: H
authors.lastname: Lessire
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pavon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D012772:Shock, Septic / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality
references.citation: Crit Care Med. 2003 Sep;31(9):2332-8
references.pmid: 14501964
references.citation: Crit Care Med. 1995 Oct;23(10):1638-52
references.pmid: 7587228
references.citation: Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):617-24
references.pmid: 8810595
references.citation: BMJ. 2001 May 26;322(7297):1274-6
references.pmid: 11375229
references.citation: Crit Care Med. 2006 Feb;34(2):344-53
references.pmid: 16424713
references.citation: N Engl J Med. 2012 May 31;366(22):2055-64
references.pmid: 22616830
references.citation: Crit Care Med. 2011 Aug;39(8):1886-95
references.pmid: 21516036
references.citation: Intensive Care Med. 1995 Nov;21 Suppl 2:S244-9
references.pmid: 8636531
references.citation: Crit Care. 2012 Feb 29;16(1):R34
references.pmid: 22377234
references.citation: Crit Care Med. 1992 Jun;20(6):864-74
references.pmid: 1597042
references.citation: Intensive Care Med. 1996 Jul;22(7):707-10
references.pmid: 8844239
references.citation: Crit Care Med. 2012 Dec;40(12):3189-95
references.pmid: 23027124
references.citation: Crit Care Med. 2009 Jan;37(1):81-8
references.pmid: 19050636
references.citation: N Engl J Med. 2001 Nov 8;345(19):1368-77
references.pmid: 11794169
references.citation: Crit Care Med. 2001 Jul;29(7):1303-10
references.pmid: 11445675
references.citation: Am J Respir Crit Care Med. 2003 Jul 1;168(1):77-84
references.pmid: 12702548
references.citation: N Engl J Med. 2001 Mar 8;344(10):699-709
references.pmid: 11236773
references.citation: Crit Care Med. 2003 Apr;31(4):1250-6
references.pmid: 12682500
references.citation: Biometrics. 1988 Mar;44(1):229-41
references.pmid: 3358991
references.citation: JAMA. 1995 Sep 27;274(12):968-74
references.pmid: 7674528
references.citation: Intensive Care Med. 2007 Mar;33(3):435-43
references.pmid: 17225161
references.citation: Intensive Care Med. 1995 Apr;21(4):302-9
references.pmid: 7650252
references.citation: Crit Care Med. 2010 Apr;38(4):1045-53
references.pmid: 20048677
references.citation: Stat Med. 2002 Jul 30;21(14):1969-89
references.pmid: 12111882
references.citation: Intensive Care Med. 2002 Feb;28(2):108-21
references.pmid: 11907653
references.citation: JAMA. 1995 Jan 11;273(2):117-23
references.pmid: 7799491
references.citation: Stat Med. 2000 Jul 30;19(14):1831-47
references.pmid: 10867674
references.citation: Crit Care Med. 1998 Nov;26(11):1793-800
references.pmid: 9824069
references.citation: Am J Respir Crit Care Med. 2003 Jul 15;168(2):165-72
references.pmid: 12851245
references.citation: Crit Care Med. 1981 Aug;9(8):591-7
references.pmid: 7261642
references.citation: Ann Fr Anesth Reanim. 2010 Sep;29(9):621-8
references.pmid: 20634026
references.citation: JAMA. 2002 Aug 21;288(7):862-71
references.pmid: 12186604
references.citation: N Engl J Med. 2003 Apr 17;348(16):1546-54
references.pmid: 12700374
references.citation: Crit Care Med. 2010 Feb;38(2):367-74
references.pmid: 20035219
references.citation: Crit Care Med. 2006 Jun;34(6):1589-96
references.pmid: 16625125
references.citation: Intensive Care Med. 2004 Apr;30(4):580-8
references.pmid: 14997295
references.citation: JAMA. 2008 May 21;299(19):2294-303
references.pmid: 18492971
references.citation: Crit Care Med. 2004 Mar;32(3):858-73
references.pmid: 15090974
references.citation: Crit Care Med. 2011 Feb;39(2):252-8
references.pmid: 21057312
references.citation: JAMA. 1993 Dec 22-29;270(24):2957-63
references.pmid: 8254858
references.citation: Intensive Care Med. 2001 Jun;27(6):999-1004
references.pmid: 11497159
references.citation: Intensive Care Med. 2004 Apr;30(4):589-96
references.pmid: 14963646
references.citation: Crit Care Med. 2011 Sep;39(9):2066-71
references.pmid: 21572327
references.citation: Lancet. 2000 Apr 1;355(9210):1138-42
references.pmid: 10791376