Open AccessA mortality analysis of septic shock, vasoplegic shock and cryptic shock classified by the third international consensus definitions (Sepsis‐3)
Author(s) -
Yang Won S.,
Kang Hui D.,
Jung Sang K.,
Lee You J.,
Oh Se H.,
Kim YounJung,
Sohn Chang H.,
Kim Won Y.
Publication year - 2020
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.13218
Subject(s) - septic shock , medicine , shock (circulatory) , sepsis , cardiology
This study aimed to compare the 28‐day mortality of patients with septic shock, defined by Sepsis‐3 criteria and patients with vasoplegic or cryptic shock who are excluded from this new definition. Objectives This retrospective observational study was performed using a tertiary emergency department's septic shock registry and investigated the records of patients managed between January 2010 and December 2015. In 2,138 total patients, 1004 (47.0%) had septic shock, 476 (22.2%) had vasoplegic shock and 655 (30.6%) had cryptic shock. Results There was significant variation in 28‐day mortality among the three groups: 23.4% for septic shock, 8.8% for vasoplegic shock and 12.2% for cryptic shock ( P < .001). In subgroup analysis of cryptic shock or septic shock according to lactate levels (2‐3, 3‐4 and >4 mmol/L), the mortality rate increased as lactate increased (cryptic shock: 9.5%, 14.8% and 18.0%; septic shock: 18.6%, 22.6% and 27.0%, respectively; P < .001). Multivariable analysis revealed odds ratios for mortality of 0.31 (95% CI 0.22‐0.44; P < .001) for vasoplegic shock and 0.46 (95% CI 0.35‐0.61; P < .001) for cryptic shock relative to septic shock. Survival curve analysis showed significant differences among patients with septic shock, vasoplegic shock and cryptic shock (Log rank test: P < .0001). Conclusion The new septic shock definition may be useful for identifying high‐risk patients requiring intensive care. However, cryptic shock‐associated mortality increased to 18.0% as serum lactate increased, which suggests that some cryptic shock patients may also require intensive management.