title: Association between hemodynamic presentation and outcome in sepsis patients.
abstract: We aimed to compare outcomes of sepsis patients according to their hemodynamic presentation: cryptic shock (CS), cryptic to overt shock (COS), and overt shock (OS). We analyzed the sepsis registry for adult patients who presented to the emergency department (ED) of a tertiary hospital and met the criteria for severe sepsis or septic shock between August 2008 and March 2012. We classified the patients as having CS, COS, or OS. "Cryptic shock" was defined as severe sepsis with a lactate level of 4 mmol/L or greater and normotension, "COS" was defined as initial CS that progressed to septic shock within 72 h, and "OS" was defined as septic shock on ED arrival. The primary outcome was in-hospital mortality. We performed a multivariable logistic regression analysis to assess variables related to in-hospital mortality and a multivariable Cox regression analysis to assess predictive factors for progression to OS in patients who initially showed CS. A total of 591 patients were included. We assigned 187 (31.6%) patients to the CS group, 157 (26.6%) patients to the COS group, and 247 (41.8%) patients to the OS group. There was a significant difference in unadjusted in-hospital mortality among groups (7.0% in the CS group, 27.4% in the COS group, and 21.9% in the OS group; P < 0.01). Multivariable analysis showed an odds ratio (OR) for in-hospital mortality of 0.17 (95% confidence interval, 0.07 - 0.40; P < 0.01) for the CS group and 0.83 (95% confidence interval, 0.46 - 1.49; P = 0.54) for the COS group compared with the OS group. A higher blood lactate concentration and respiratory failure were significant risk factors for progression to OS. In conclusion, CS without deterioration to hypotension during initial treatment showed significantly lower mortality than OS. The mortality from CS that progressed to apparent hypotension, however, was comparable to the mortality associated with OS.
authors: *Departments of Emergency Medicine, †Critical Care Medicine, and ‡Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Sung Yeon
authors: SY
authors: Hwang
authors: Tae Gun
authors: TG
authors: Shin
authors: Ik Joon
authors: IJ
authors: Jo
authors: Kyeongman
authors: K
authors: Jeon
authors: Gee Young
authors: GY
authors: Suh
authors: Tae Rim
authors: TR
authors: Lee
authors: Won Chul
authors: WC
authors: Cha
authors: Min Seob
authors: MS
authors: Sim
authors: Keun Jeong
authors: KJ
authors: Song
authors: Yeon Kwon
authors: YK
authors: Jeong
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016009:Chi-Square Distribution; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000503:physiopathology; D019344:Lactic Acid / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D062606:Tertiary Care Centers; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019344:Lactic Acid