Seung Mok Ryoo1, Gu Hyun Kang2, Tae Gun Shin3, Sung Yeon Hwang3, Kyuseok Kim4, You Hwan Jo4, Yoo Seok Park5, Sung-Hyuk Choi6, Young Hoon Yoon6, Woon Yong Kwon7, Gil Joon Suh7, Tae Ho Lim8, Kap Su Han9, Han Sung Choi10, Sung Phil Chung5, Won Young Kim1. 1. Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. 2. Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Republic of Korea. 3. Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 5. Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. 6. Department of Emergency Medicine, Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea. 7. Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. 8. Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea. 9. Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Republic of Korea. 10. Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
Abstract
BACKGROUND: We compared the clinical characteristics and outcomes between the new definition of sepsis-3 septic shock and the definition previously used from 1991 until recently. METHODS: We conducted an observational study using a prospective, multi-center registry of septic shock from October 2015 to February 2017. Registry data were collected by 10 emergency departments (EDs) in tertiary hospitals that are members of the Korean Shock Society. Data on septic shock patients who met the previous septic shock definition were collected. The patients were divided into a sepsis-3 defined septic shock group, made up of those who met the new criteria for refractory hypotension with hyperlactatemia, and a group of those who met only the 1991 definition for septic shock. The primary outcome was 90-day mortality, and secondary outcomes were 28-day mortality and in-hospital mortality. RESULTS: Of all 1,028 included patients, 574 (55.8%) met the septic shock criteria for sepsis-3, leaving 454 patients who met only the previous definition. Those who met the sepsis-3 criteria demonstrated higher comorbidity than those who met the previous definition (83.1% vs. 75.3%, P<0.01), but there was no difference in infection focus. The sequential organ failure assessment (SOFA) (initial/maximal), the acute physiology, and the chronic health evaluation II scores were significantly higher in for those who met the sepsis-3 criteria [6.5±3.1 vs. 5.0±2.9, 9.3±3.8 vs. 6.6±3.4, and 20.0 (15.0-26.0) vs. 15.0 (10.0-20.3), respectively; P<0.01]. The 90-day mortality was significantly higher in the sepsis-3 group (32.1% vs. 23.3%; P<0.01). In-hospital and 28-day mortality were also higher in the sepsis-3 group (26.8% vs. 17.1% and 25.1% vs. 16.5%, respectively; P<0.01). CONCLUSIONS: The new definition of septic shock successfully selected patients with greater severities and worse outcomes.
BACKGROUND: We compared the clinical characteristics and outcomes between the new definition of sepsis-3 septic shock and the definition previously used from 1991 until recently. METHODS: We conducted an observational study using a prospective, multi-center registry of septic shock from October 2015 to February 2017. Registry data were collected by 10 emergency departments (EDs) in tertiary hospitals that are members of the Korean Shock Society. Data on septic shock patients who met the previous septic shock definition were collected. The patients were divided into a sepsis-3 defined septic shock group, made up of those who met the new criteria for refractory hypotension with hyperlactatemia, and a group of those who met only the 1991 definition for septic shock. The primary outcome was 90-day mortality, and secondary outcomes were 28-day mortality and in-hospital mortality. RESULTS: Of all 1,028 included patients, 574 (55.8%) met the septic shock criteria for sepsis-3, leaving 454 patients who met only the previous definition. Those who met the sepsis-3 criteria demonstrated higher comorbidity than those who met the previous definition (83.1% vs. 75.3%, P<0.01), but there was no difference in infection focus. The sequential organ failure assessment (SOFA) (initial/maximal), the acute physiology, and the chronic health evaluation II scores were significantly higher in for those who met the sepsis-3 criteria [6.5±3.1 vs. 5.0±2.9, 9.3±3.8 vs. 6.6±3.4, and 20.0 (15.0-26.0) vs. 15.0 (10.0-20.3), respectively; P<0.01]. The 90-day mortality was significantly higher in the sepsis-3 group (32.1% vs. 23.3%; P<0.01). In-hospital and 28-day mortality were also higher in the sepsis-3 group (26.8% vs. 17.1% and 25.1% vs. 16.5%, respectively; P<0.01). CONCLUSIONS: The new definition of septic shock successfully selected patients with greater severities and worse outcomes.
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