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Has the mortality of septic shock changed with time
G Friedman1, E Silva, J L Vincent
1Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Critical Care Medicine
|January 6, 1999
Summary
This review found a slight decrease in septic shock mortality over time, but results should be interpreted cautiously due to study limitations. Changes in infection sources and causative organisms were also noted.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Septic shock remains a significant cause of mortality worldwide.
- Understanding temporal trends in septic shock outcomes is crucial for improving patient care.
- Previous reviews have not comprehensively analyzed long-term mortality changes.
Purpose of the Study:
- To systematically review the literature and identify trends in septic shock mortality from 1958 to 1997.
- To analyze changes in causative organisms and infection origins over time.
Main Methods:
- A comprehensive MEDLINE search and bibliography review identified 131 relevant studies.
- Data from 10,694 patients were analyzed, spanning prospective and retrospective studies.
- Statistical analysis assessed mortality trends, organism prevalence, and infection sites.
Main Results:
- Overall septic shock mortality showed a slight but significant decreasing trend (49.7% mortality).
- Mortality was higher in patients with bacteremia compared to sepsis without bacteremia.
- A notable shift occurred in infection sources from abdomen to chest, with increasing Gram-positive organism prevalence.
Conclusions:
- A modest reduction in septic shock mortality was observed over the study period.
- Study heterogeneity and lack of severity scores limit definitive conclusions.
- Increasing Gram-positive infections and a shift in infection origin necessitate ongoing research and treatment adaptation.