title: Reasons for death in patients with sepsis and septic shock.
abstract: Understanding the underlying cause of mortality in sepsis has broad implications for both clinical care and interventional trial design. However, reasons for death in sepsis remain poorly understood. We sought to characterize reasons for in-hospital mortality in a population of patients with sepsis or septic shock.
  
  
  
  We performed a retrospective review of patients admitted to the intensive care unit with sepsis or septic shock who died during their index admission. Reasons for death were classified into 6 categories determined a priori by group consensus. Interrater reliability was calculated and Fleiss κ reported. The associations between selected patient characteristics (eg, serum lactate) and reason for death were also assessed.
  
  
  
  One hundred fifteen patients were included. Refractory shock (40%) and comorbid withdrawal of care (44%) were the most common reasons for death. Overall interrater agreement was substantial (κ = 0.61, P<.01). Lactate was higher in patients who died because of refractory shock as compared with those who died for other reasons (4.7 vs 2.8 mmol/L, P<.01).
  
  
  
  In this retrospective cohort, refractory shock and comorbid withdrawal of care were the most common reasons for death. Following prospective validation, the classification methodology presented here may be useful in the design/interpretation of trials in sepsis.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Ari
authors.initials: A
authors.lastname: Moskowitz
authors.affiliation: Department of Internal Medicine, State University of New York State at Buffalo, Buffalo, NY.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Omar
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Chase
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA.
authors.forename: Sharukh
authors.initials: S
authors.lastname: Lokhandwala
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Parth
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars W
authors.initials: LW
authors.lastname: Andersen
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Critical Care, Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mdonnino@bidmc.harvard.edu.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D032921:Consensus; D016757:Death, Sudden, Cardiac; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000401:mortality*; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000401:mortality; D012772:Shock, Septic / Q000097:blood / Q000401:mortality*; D028761:Withholding Treatment
chemical_list: D019344:Lactic Acid
keywords: Classification; Lactate; Sepsis