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National Trends in Timing of Death Among Patients With Septic Shock, 1994-2014.
Crit Care Med. 2019 11; 47(11):1493-1496.CC

Abstract

OBJECTIVES

To assess trends in timing of mortality among patients with septic shock.

DESIGN

Retrospective cohort study.

SETTING

Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project's National Inpatient Sample, 1994-2014.

PATIENTS

Hospitalized adults (≥ 18 yr) with International Classification of Diseases, 9th Edition, Clinical Modification codes consistent with septic shock; secondary analysis: adults with International Classification of Diseases, 9th Edition, Clinical Modification codes consistent with acute respiratory failure receiving invasive mechanical ventilation and patients with both septic shock and acute respiratory failure receiving invasive mechanical ventilation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

From 1994 to 2014, 48-hour mortality rates decreased among patients with septic shock (21.2% to 10.8%) and septic shock with acute respiratory failure receiving invasive mechanical ventilation (19.1% to 13.4%) but increased among patients with acute respiratory failure receiving invasive mechanical ventilation (7.9% to 9.8%; p value for all trends, < 0.001). Three-to-14-day mortality decreased among patients with septic shock (22.1% to 15.5%), septic shock with acute respiratory failure receiving invasive mechanical ventilation (28.7% to 22.4%) and acute respiratory failure receiving invasive mechanical ventilation (16.8% to 15.0%; p value for all trends, < 0.001). Mortality after 14 days decreased among all groups (septic shock: 12.6% to 6.7%; septic shock with acute respiratory failure receiving invasive mechanical ventilation: 20.3% to 11.3%; and acute respiratory failure receiving invasive mechanical ventilation: 12.7% to 5.8%; p value for all trends, < 0.001). Cox proportional hazard ratio for declining risk in mortality per year (adjusted for patient and hospital characteristics) was 0.96 (95% CI, 0.96-0.96) for septic shock, 0.97 (0.97-0.97) for acute respiratory failure receiving invasive mechanical ventilation and septic shock, and 0.99 (0.99-0.99) for acute respiratory failure receiving invasive mechanical ventilation.

CONCLUSIONS

Septic shock 48-hour, 3-14-day and greater than 14-day mortality declined markedly over two decades; in contrast, patients with acute respiratory failure only experienced marked decreases in greater than 14-day in-hospital mortality rates.

Authors+Show Affiliations

Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA. The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

31397713

Citation

Law, Anica C., et al. "National Trends in Timing of Death Among Patients With Septic Shock, 1994-2014." Critical Care Medicine, vol. 47, no. 11, 2019, pp. 1493-1496.
Law AC, Stevens JP, Walkey AJ. National Trends in Timing of Death Among Patients With Septic Shock, 1994-2014. Crit Care Med. 2019;47(11):1493-1496.
Law, A. C., Stevens, J. P., & Walkey, A. J. (2019). National Trends in Timing of Death Among Patients With Septic Shock, 1994-2014. Critical Care Medicine, 47(11), 1493-1496. https://doi.org/10.1097/CCM.0000000000003956
Law AC, Stevens JP, Walkey AJ. National Trends in Timing of Death Among Patients With Septic Shock, 1994-2014. Crit Care Med. 2019;47(11):1493-1496. PubMed PMID: 31397713.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - National Trends in Timing of Death Among Patients With Septic Shock, 1994-2014. AU - Law,Anica C, AU - Stevens,Jennifer P, AU - Walkey,Allan J, PY - 2019/8/10/pubmed PY - 2020/5/26/medline PY - 2019/8/10/entrez SP - 1493 EP - 1496 JF - Critical care medicine JO - Crit Care Med VL - 47 IS - 11 N2 - OBJECTIVES: To assess trends in timing of mortality among patients with septic shock. DESIGN: Retrospective cohort study. SETTING: Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project's National Inpatient Sample, 1994-2014. PATIENTS: Hospitalized adults (≥ 18 yr) with International Classification of Diseases, 9th Edition, Clinical Modification codes consistent with septic shock; secondary analysis: adults with International Classification of Diseases, 9th Edition, Clinical Modification codes consistent with acute respiratory failure receiving invasive mechanical ventilation and patients with both septic shock and acute respiratory failure receiving invasive mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 1994 to 2014, 48-hour mortality rates decreased among patients with septic shock (21.2% to 10.8%) and septic shock with acute respiratory failure receiving invasive mechanical ventilation (19.1% to 13.4%) but increased among patients with acute respiratory failure receiving invasive mechanical ventilation (7.9% to 9.8%; p value for all trends, < 0.001). Three-to-14-day mortality decreased among patients with septic shock (22.1% to 15.5%), septic shock with acute respiratory failure receiving invasive mechanical ventilation (28.7% to 22.4%) and acute respiratory failure receiving invasive mechanical ventilation (16.8% to 15.0%; p value for all trends, < 0.001). Mortality after 14 days decreased among all groups (septic shock: 12.6% to 6.7%; septic shock with acute respiratory failure receiving invasive mechanical ventilation: 20.3% to 11.3%; and acute respiratory failure receiving invasive mechanical ventilation: 12.7% to 5.8%; p value for all trends, < 0.001). Cox proportional hazard ratio for declining risk in mortality per year (adjusted for patient and hospital characteristics) was 0.96 (95% CI, 0.96-0.96) for septic shock, 0.97 (0.97-0.97) for acute respiratory failure receiving invasive mechanical ventilation and septic shock, and 0.99 (0.99-0.99) for acute respiratory failure receiving invasive mechanical ventilation. CONCLUSIONS: Septic shock 48-hour, 3-14-day and greater than 14-day mortality declined markedly over two decades; in contrast, patients with acute respiratory failure only experienced marked decreases in greater than 14-day in-hospital mortality rates. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/31397713/National_Trends_in_Timing_of_Death_Among_Patients_With_Septic_Shock_1994_2014_ L2 - https://dx.doi.org/10.1097/CCM.0000000000003956 DB - PRIME DP - Unbound Medicine ER -