Predictors of Progression to Shock in Patients with Sepsis

Authors: Capp R et al., Crit Care Med 2015 Jan 30;

Nonpersistent hypotension and lactate level ≥4.0 mmol/L were the strongest predictors of progression to septic shock 4 to 48 hours after presentation.

Among patients with sepsis, only a few progress to severe sepsis or septic shock. In these patients, however, early and aggressive treatment improves outcomes. To identify factors predictive of progression to septic shock, researchers conducted a retrospective chart review of 18,100 adult emergency department (ED) patients admitted to two tertiary teaching hospitals and identified 1316 who met criteria for sepsis within 4 hours of arrival. Of these patients, 111 (8.4%) were not initially in septic shock but progressed to septic shock within 48 hours.

Using multivariable logistic regression analysis, the authors identified five significant predictors of progression to septic shock: nonpersistent hypotension (systolic blood pressure <90 mm Hg; odds ratio, 6.2), lactate level ≥4.0 mmol/L (OR, 5.3), bandemia ≥10% (OR, 2.6), history of coronary artery disease (OR, 2.0), and female sex (OR, 1.6).

Comment
Don’t let your guard down when hypotension seems to respond to initial fluid resuscitation. In this cohort, nonpersistent hypotension was even more worrisome than lactate level >4.0 mmol/L.