Postdoctoral Fellow II Galveston, Texas, United States
Disclosure(s):
Lucineia Danielski, PharmD: No financial relationships to disclose
Background: Severe sepsis is a progression from sepsis, and septic shock represents the most severe end of the sepsis spectrum and is associated with profound circulatory and metabolic abnormalities. However, the magnitude and persistence of its impact on short- and long-term mortality across extended follow-up periods remain incompletely characterized.
Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, which aggregates de-identified electronic health record data from 68 healthcare organizations across the United States. Adult patients (≥18 years) hospitalized with a diagnosis of sepsis were identified using ICD-10 codes A40–A41 and were categorized into: sepsis with septic shock (ICD-10 R65.21, excluding R65.20) and sepsis without septic shock (ICD-10 R65.20, excluding R65.21). Classification required that the shock designation be recorded within 7 days of the initial sepsis diagnosis or hospital admission. The index date was defined as the first date on which patients met criteria for their respective cohort. To minimize confounding, 1:1 propensity score matching was performed using baseline demographic and clinical characteristics, such as cardiorespiratory and metabolic comorbidities, yielding well-balanced cohorts. Outcomes of interest included all-cause mortality, acute respiratory distress syndrome, acute kidney injury, disseminated intravascular coagulation, delirium, antimicrobial prescription, and discharge disposition. Outcomes were assessed at predefined time points of 30 days and 90 days following the index date. Time-to-event analyses were conducted using Kaplan–Meier survival curves, with between-group comparisons performed using the log-rank test. Effect estimates were reported as hazard ratios with 95% confidence intervals.
Outcome: Before propensity score matching, 299,405 patients with septic shock and 303,775 patients with sepsis without shock were identified. After 1:1 propensity score matching (284,577 patients per cohort), septic shock was associated with markedly higher short-term mortality compared with sepsis without shock at 30 days (HR 3.69, 95% CI 3.64–3.74) and 90 days (HR 3.39, 95% CI 3.35–3.43). Septic shock was also associated with increased risks of acute respiratory distress syndrome (30 days: HR 4.78; 90 days: HR 4.73), acute kidney injury (30 days: HR 1.51; 90 days: HR 1.50), disseminated intravascular coagulation (30 days: HR 5.61; 90 days: HR 5.39), and delirium (30 days: HR 1.69; 90 days: HR 1.65). In contrast, patients with septic shock were less likely to receive antimicrobial exposure (30 days: HR 0.95; 90 days: HR 0.96) and less likely to be discharged to post-acute care services at both time points.
Conclusion: Shock after sepsis is associated with markedly higher early mortality and complication rates compared with sepsis without shock, with significantly elevated risks evident within the first 30 and 90 days after hospitalization.
