title: Timing and causes of death in septic shock.
abstract: BACKGROUND
  Most studies about septic shock report a crude mortality rate that neither distinguishes between early and late deaths nor addresses the direct causes of death. We herein aimed to determine the modalities of death in septic shock.
  
  
  METHODS
  This was a 6-year (2008-2013) monocenter retrospective study. All consecutive patients diagnosed for septic shock within the first 48 h of intensive care unit (ICU) admission were included. Early and late deaths were defined as occurring within or after 3 days following ICU admission, respectively. The main cause of death in the ICU was determined from medical files. A multinomial logistic regression analysis using the status alive as the reference category was performed to identify the prognostic factors associated with early and late deaths.
  
  
  RESULTS
  Five hundred forty-three patients were included, with a mean age of 66 ± 15 years and a high proportion (67 %) of comorbidities. The in-ICU and in-hospital mortality rates were 37.2 and 45 %, respectively. Deaths occurred early for 78 (32 %) and later on for 166 (68 %) patients in the ICU (n = 124) or in the hospital (n = 42). Early deaths were mainly attributable to intractable multiple organ failure related to the primary infection (82 %) and to mesenteric ischemia (6.4 %). In-ICU late deaths were directly related to end-of-life decisions in 29 % of patients and otherwise mostly related to ICU-acquired complications, including nosocomial infections (20.4 %) and mesenteric ischemia (16.6 %). Independent determinants of early death were age, malignancy, diabetes mellitus, no pathogen identification, and initial severity. Among 3-day survivors, independent risk factors for late death were age, cirrhosis, no pathogen identification, and previous corticosteroid treatment.
  
  
  CONCLUSIONS
  Our study provides a comprehensive assessment of septic shock-related deaths. Identification of risk factors of early and late deaths may determine differential prognostic patterns.
authors.affiliation: Réanimation médicale, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France, daviaudfabrice@gmail.com.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Daviaud
authors.forename: David
authors.initials: D
authors.lastname: Grimaldi
authors.forename: Agnès
authors.initials: A
authors.lastname: Dechartres
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.forename: Nathalie
authors.initials: N
authors.lastname: Marin
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène