Varying Presentations and Outcomes of Septic Shock: Should Septic Shock be Stratified?

Abstract

Recent studies have revealed there are three presentations of septic shock in patients: refractory hypotension without hyperlactatemia, hyperlactatemia without refractory hypotension, and both refractory hypotension and hyperlactatemia. In this study, we sought to identify differences in the outcomes of septic shock patients with these three presentations. We performed a secondary analysis of a large-scale, multicenter, controlled trial. The septic shock patients were categorized into the following three groups according to the presence or absence of refractory hypotension and hyperlactatemia: a hypotension group (refractory hypotension without hyperlactatemia), a hyperlactatemia group (hyperlactatemia without refractory hypotension), and a typical group (both refractory hypotension and hyperlactatemia). The 90-day all-cause mortality was compared among these three groups. A total of 1588 septic shock patients were enrolled in the present study, including 854 (53.8%) in the hypotension group, 477 (30.0%) in the hyperlactatemia group, and 257 (16.2%) in the typical group. The 90-day all-cause mortality were 12.3 per cent for the patients in the hypotension group, 23.1 per cent for those in the hyperlactatemia group, and 31.9 per cent for those inthe typical group, these differences among the three groups were significant (Pearson's χ2 = 58.49, P < 0.001). And also, there was a significant difference between hyperlactatemia group and typical group (Pearson's χ2 = 6.77, P < 0.05). In this study, we demonstrated that the three different presentations of septic shock resulted in significantly different outcomes, suggesting that septic shock should be stratified.

Examining the association between triage streamed treatment location and time to appropriate antibiotics in emergency department patients with septic shock

“…18 This large stratified septic shock cohort study (n = 1588) examined 90-day all-cause mortality and found LS with the absence of hypotension to convey higher mortality than CV shock alone. 16 This is also supported in another ED septic shock cohort study which demonstrated higher in-hospital mortality in those with hyperlactataemia compared to refractory hypotension. 17 It has been highlighted that sepsis patients with hyperlactataemia can receive delays to antibiotics if normotensive when compared to hypotensive patients.…”

“…Elevated lactate, a clinical feature of septic shock, is a confirmed prognosticator for increased mortality and death 18 . This large stratified septic shock cohort study ( n = 1588) examined 90‐day all‐cause mortality and found LS with the absence of hypotension to convey higher mortality than CV shock alone 16 . This is also supported in another ED septic shock cohort study which demonstrated higher in‐hospital mortality in those with hyperlactataemia compared to refractory hypotension 17 …”

“…Recent research has examined outcomes in septic shock patients stratified by phenotypes categorised into three groups according to the presence or absence of refractory hypotension and hyperlactataemia. 16,17 Elevated lactate, a clinical feature of septic shock, is a confirmed prognosticator for increased mortality and death. 18 This large stratified septic shock cohort study (n = 1588) examined 90-day all-cause mortality and found LS with the absence of hypotension to convey higher mortality than CV shock alone.…”

“…This group overall had significant delays to antibiotics. Recent research has examined outcomes in septic shock patients stratified by phenotypes categorised into three groups according to the presence or absence of refractory hypotension and hyperlactataemia 16,17 . Elevated lactate, a clinical feature of septic shock, is a confirmed prognosticator for increased mortality and death 18 .…”