title: Increased survival of cirrhotic patients with septic shock.
abstract: BACKGROUND
  The overall outcome of septic shock has been recently improved. We sought to determine whether this survival gain extends to the high-risk subgroup of patients with cirrhosis.
  
  
  METHODS
  Cirrhotic patients with septic shock admitted to a medical intensive care unit (ICU) during two consecutive periods (1997-2004 and 2005-2010) were retrospectively studied.
  
  
  RESULTS
  Forty-seven and 42 cirrhotic patients presented with septic shock in 1997-2004 and 2005-2010, respectively. The recent period differed from the previous one by implementation of adjuvant treatments of septic shock including albumin infusion as fluid volume therapy, low-dose glucocorticoids, and intensive insulin therapy. ICU and hospital survival markedly improved over time (40% in 2005-2010 vs. 17% in 1997-2004, P = 0.02 and 29% in 2005-2010 vs. 6% in 1997-2004, P = 0.009, respectively). Furthermore, this survival gain in the latter period was sustained for 6 months (survival rate 24% in 2005-2010 vs. 6% in 1997-2004, P = 0.06). After adjustment with age, the liver disease stage (Child-Pugh score), and the critical illness severity score (SOFA score), ICU admission between 2005 and 2010 remained an independent favorable prognostic factor (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.02-0.4, P = 0.004). The stage of the underlying liver disease was also independently associated with hospital mortality (Child-Pugh score: OR 1.42 per point, 95% CI 1.06-1.9, P = 0.018).
  
  
  CONCLUSIONS
  In the light of advances in management of both cirrhosis and septic shock, survival of such patients substantially increased over recent years. The stage of the underlying liver disease and the related therapeutic options should be included in the decision-making process for ICU admission.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sauneuf
authors.forename: Benoit
authors.initials: B
authors.lastname: Champigneulle
authors.forename: Alexis
authors.initials: A
authors.lastname: Soummer
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mongardon
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.forename: Vincent
authors.initials: V
authors.lastname: Mallet
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome