title: Septic shock: a major cause of hospital death after intensive care unit discharge.
abstract: OBJECTIVE
  To assess the causes and factors associated with the death of patients between intensive care unit discharge and hospital discharge.
  
  
  METHODS
  The present is a pilot, retrospective, observational cohort study. The records of all patients admitted to two units of a public/private university hospital from February 1, 2013 to April 30, 2013 were assessed. Demographic and clinical data, risk scores and outcomes were obtained from the Epimed monitoring system and confirmed in the electronic record system of the hospital. The relative risk and respective confidence intervals were calculated.
  
  
  RESULTS
  A total of 581 patients were evaluated. The mortality rate in the intensive care unit was 20.8% and in the hospital was 24.9%. Septic shock was the cause of death in 58.3% of patients who died after being discharged from the intensive care unit. Of the patients from the public health system, 73 (77.6%) died in the intensive care unit and 21 (22.4%) died in the hospital after being discharged from the unit. Of the patients from the Supplementary Health System, 48 (94.1%) died in the intensive care unit and 3 (5.9%) died in the hospital after being discharged from the unit (relative risk, 3.87%; 95% confidence interval, 1.21 - 12.36; p < 0.05). The post-discharge mortality rate was significantly higher in patients with intensive care unit hospitalization time longer than 6 days.
  
  
  CONCLUSIONS
  The main cause of death of patients who were discharged from the intensive care unit and died in the ward before hospital discharge was septic shock. Coverage by the public healthcare system and longer hospitalization time in the intensive care unit were factors associated with death after discharge from the intensive care unit.
authors.affiliation: Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.
authors.forename: Matheus Gomes
authors.initials: MG
authors.lastname: Giacomini
authors.affiliation: Serviço de Terapia Intensiva, Hospital de Base de São José do Rio Preto, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.
authors.forename: Márcia Valéria Caldeira Angelucci
authors.initials: MV
authors.lastname: Lopes
authors.affiliation: Serviço de Terapia Intensiva, Hospital de Base de São José do Rio Preto, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.
authors.forename: Joelma Villafanha
authors.initials: JV
authors.lastname: Gandolfi
authors.affiliation: Serviço de Terapia Intensiva, Hospital de Base de São José do Rio Preto, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.
authors.forename: Suzana Margareth Ajeje
authors.initials: SM
authors.lastname: Lobo
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010865:Pilot Projects; D012189:Retrospective Studies; D012772:Shock, Septic / Q000453:epidemiology / Q000401:mortality*; D013997:Time Factors