Mortality risk factors for patients with severe sepsis and septic shock treated with early goal-directed therapy

Abstract

Severe sepsis remains a leading cause of death despite advances in critical care management. Early goal-directed therapy (EGDT) is known to be a treatment process that reduces morbidity and mortality. This study aimed at evaluating the risk factors of mortality in patients with severe sepsis and septic shock who received EGDT. We conducted a retrospective cohort study. Patients with severe sepsis and septic shock who received EGDT between November 2007 and November 2011 at an urban emergency department were included. The primary outcome was all cause 7- and 28-day mortality. A total of 436 patients were eligible for analysis. The 7- and 28-day mortality rates were 7.11% (31/436) and 14% (61/436), respectively. In multivariate analysis, high lactate levels (odds ratio [OR] 1.286; 95% confidence interval [CI] 1.016-1.627; p=0.036) and low eGFR (OR: 0.953; 95% CI: 0.913-0.996; p=0.032) were independent risk factors for 7-day mortality. For 28-day mortality, high lactate level (OR: 1.346; 95% CI: 1.083-1.673; p=0.008) and a high APACHE II score (OR: 1.153; 95% CI: 1.029-1.293; p=0.014) were found to be risk factors. Organ dysfunction such as renal failure requiring hemodialysis and a high lactate level were independent risk factors for mortality in patients with severe sepsis and septic shock who were successfully treated with EGDT.