title: Characteristics and outcomes of patients with vasoplegic versus tissue dysoxic septic shock.
abstract: BACKGROUND
  The current consensus definition of septic shock requires hypotension after adequate fluid challenge or vasopressor requirement. Some patients with septic shock present with hypotension and hyperlactatemia greater than 2 mmol/L (tissue dysoxic shock), whereas others have hypotension alone with normal lactate (vasoplegic shock).
  
  
  OBJECTIVE
  The objective of this study was to determine differences in outcomes of patients with tissue dysoxic versus vasoplegic septic shock.
  
  
  METHODS
  This was a secondary analysis of a large, multicenter randomized controlled trial. Inclusion criteria were suspected infection, two or more systemic inflammatory response criteria, and systolic blood pressure less than 90 mmHg after a fluid bolus. Patients were categorized by presence of vasoplegic or tissue dysoxic shock. Demographics and Sequential Organ Failure Assessment scores were evaluated between the groups. The primary outcome was in-hospital mortality.
  
  
  RESULTS
  A total of 247 patients were included, 90 patients with vasoplegic shock and 157 with tissue dysoxic shock. There were no significant differences in age, race, or sex between the vasoplegic and tissue dysoxic shock groups. The group with vasoplegic shock had a lower initial Sequential Organ Failure Assessment score than did the group with tissue dysoxic shock (5.5 vs. 7.0 points; P = 0.0002). The primary outcome of in-hospital mortality occurred in 8 (9%) of 90 patients with vasoplegic shock compared with 41 (26%) of 157 in the group with tissue dysoxic shock (proportion difference, 17%; 95% confidence interval, 7%-26%; P < 0.0001; log-rank test P = 0.02). After adjusting for confounders, tissue dysoxic shock remained an independent predictor of in-hospital mortality.
  
  
  CONCLUSIONS
  In this analysis of patients with septic shock, we found a significant difference in in-hospital mortality between patients with vasoplegic versus tissue dysoxic septic shock. These findings suggest a need to consider these differences when designing future studies of septic shock therapies.
authors: Department of Emergency Medicine, University of Mississippi School of Medicine, Jackson, Mississippi 39216, USA.
authors: Sarah A
authors: SA
authors: Sterling
authors: Michael A
authors: MA
authors: Puskarich
authors: Nathan I
authors: NI
authors: Shapiro
authors: Stephen
authors: S
authors: Trzeciak
authors: Jeffrey A
authors: JA
authors: Kline
authors: Richard L
authors: RL
authors: Summers
authors: Alan E
authors: AE
authors: Jones
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000401:mortality* / Q000503:physiopathology*
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