| Title |
Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study
|
|---|---|
| Published in |
Critical Care, November 2016
|
| DOI | 10.1186/s13054-016-1537-5 |
| Pubmed ID | |
| Authors |
Damien Contou, Damien Roux, Sébastien Jochmans, Rémi Coudroy, Emmanuel Guérot, David Grimaldi, Sylvie Ricome, Eric Maury, Gaëtan Plantefève, Julien Mayaux, Armand Mekontso Dessap, Christian Brun-Buisson, Nicolas de Prost |
| Abstract |
The lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic shock to those of others. We conducted a pragmatic, prospective, multicenter observational cohort study in ten intensive care units (ICU) in France. We included all consecutive patients admitted to the ICU with suspected septic shock defined by clinical suspicion of infection leading to antibiotic prescription plus acute circulatory failure requiring vasopressor support. A total of 508 patients were admitted with suspected septic shock. Among them, 374 (74 %) had early-confirmed septic shock, while the 134 others (26 %) had no source of infection identified nor microbiological documentation retrieved 24 hours after shock onset. Among these, 37/134 (28 %) had late-confirmed septic shock diagnosed after 24 hours, 59/134 (44 %) had a condition mimicking septic (septic shock mimicker, mainly related to adverse drug reactions, acute mesenteric ischemia and malignancies) and 38/134 (28 %) had shock of unknown origin by the end of the ICU stay. There were no differences between patients with early-confirmed septic shock and the remainder in ICU mortality and the median duration of ICU stay, of tracheal intubation and of vasopressor support. The multivariable Cox model showed that the risk of day-60 mortality did not differ between patients with or without early-confirmed septic shock. A sensitivity analysis was performed in the subgroup (n = 369/508) of patients meeting the Sepsis-3 definition criteria and displayed consistent results. One quarter of the patients admitted in the ICU with suspected septic shock had no infection identified 24 hours after its onset and almost half of them were eventually diagnosed with a septic shock mimicker. Outcome did not differ between patients with early-confirmed septic shock and other patients. |
X Demographics
The data shown below were collected from the profiles of 103 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Japan | 12 | 12% |
| United Kingdom | 4 | 4% |
| South Africa | 2 | 2% |
| Mexico | 2 | 2% |
| Argentina | 2 | 2% |
| Spain | 2 | 2% |
| Chile | 1 | <1% |
| Saudi Arabia | 1 | <1% |
| Germany | 1 | <1% |
| Other | 4 | 4% |
| Unknown | 72 | 70% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 91 | 88% |
| Practitioners (doctors, other healthcare professionals) | 9 | 9% |
| Scientists | 2 | 2% |
| Science communicators (journalists, bloggers, editors) | 1 | <1% |
Mendeley readers
The data shown below were compiled from readership statistics for 116 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | <1% |
| Unknown | 115 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 16 | 14% |
| Student > Postgraduate | 13 | 11% |
| Researcher | 11 | 9% |
| Student > Bachelor | 11 | 9% |
| Student > Ph. D. Student | 8 | 7% |
| Other | 28 | 24% |
| Unknown | 29 | 25% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 61 | 53% |
| Engineering | 6 | 5% |
| Pharmacology, Toxicology and Pharmaceutical Science | 6 | 5% |
| Nursing and Health Professions | 5 | 4% |
| Biochemistry, Genetics and Molecular Biology | 3 | 3% |
| Other | 5 | 4% |
| Unknown | 30 | 26% |
Attention Score in Context
This research output has an Altmetric Attention Score of 79. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 14 March 2024.
All research outputs
#546,072
of 25,552,933 outputs
Outputs from Critical Care
#355
of 6,584 outputs
Outputs of similar age
#10,469
of 318,510 outputs
Outputs of similar age from Critical Care
#7
of 112 outputs
Altmetric has tracked 25,552,933 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 97th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,584 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.8. This one has done particularly well, scoring higher than 94% of its peers.
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