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Ryota Sato, MD
Staff Intensivist
The Queens Medical Center
Honolulu, Hawaii
Disclosure information not submitted.
Ashish Khanna, MD, FCCP, FASA,FCCM
Anesthesiologist & Intensivist, Associate Professor of Anesthesiology
Wake Forest Baptist Medical Center
Winston Salem, North Carolina
Disclosure information not submitted.
Abhijit Duggal, MD, MPH, MSc, FACP
Assistant Professor
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Siddharth Dugar, MD, FCCM
Associate Staff
Cleveland Clinic Foundation
Cleveland, Ohio
Disclosure information not submitted.
Title: Early- vs. Late- Onset Septic Shock - Does it really matter?
Introduction: It has not yet been established whether the timing of shock-onset affects the mortality in septic patients. Therefore, the aim of this study was to evaluate the impact of the timing of shock-onset on in-hospital mortality among patients with septic shock.
Methods: This single-center, retrospective cohort study included patients with septic shock admitted to the medical intensive care unit (ICU) at a quaternary center from 01/01/2011 to 12/31/2020. A multivariate logistic regression model was developed to assess if the time from hospital admission to onset of shock (initiation of vasopressors) was associated with higher in-hospital mortality. Early-onset and late-onset septic shock were defined as vasopressor support within 7 days and more than 7 days from hospital admission, respectively. The primary outcome was in-hospital mortality. The secondary outcome was ICU mortality.
RESULT: A total of 3,508 patients with septic shock (2,821 early-onset and 687 late-onset septic shock) were included. In patients with late-onset septic shock, patients were younger [median (years): 62 vs. 63, p< 0.01], and more inclined to have malignancy (34.1% vs. 22.3%, p< 0.01) and immunosuppression (39.6% vs. 26.7%, p< 0.01). The overall in-hospital mortality was 40.6% (early-onset: 37.4%, and late-onset: 53.7%). After controlling for baseline characteristics, past medical history, and vasopressor requirements within the first 24 hours of septic shock, late-onset septic shock, compared to early-onset septic shock, was associated with significantly higher in-hospital mortality [odds ratio (OR): 2.22, 95% confidence interval (CI): 1.72 – 2.85, p < 0.01]. Late-onset septic shock was also associated with higher ICU-mortality (OR: 1.31, 95%CI: 1.00 – 1.71, p=0.05).
Conclusion: In this study, late-onset septic shock ( > 7days) after hospital admission was associated with a significantly higher in-hospital mortality compared to early-onset septic shock. This finding raises the need for a better understanding of the difference in the pathophysiology, diagnostic criteria, and necessary therapeutic interventions between early-onset septic shock and late-onset septic shock.