Mortality/Morbidity of Septic Shock

The mortality rate of severe sepsis and septic shock is frequently quoted as
anywhere from 20-50%. Given that there is a spectrum of disease from sepsis to
severe sepsis to septic shock, mortality varies depending on the degree of
illness. Factors that are consistently associated with increased mortality in sepsis
include advanced age, comorbid conditions, and clinical evidence of organ
dysfunction. Simply meeting SIRS criteria without evidence of organ dysfunction
has not been shown to predict increased mortality, although increasing number
of SIRS criteria met has been associated with higher mortality.

The National Center for Health Statistics study showed a reduction in hospital
mortality rates from 28% to 18% for septicemia over the years; however, more
overall deaths occurred due to the increased incidence of sepsis. The study by
Angus et al, which likely more accurately reflects the incidence of severe sepsis
and septic shock, reported a mortality rate of about 30%.

The morbidity of sepsis is significant given that tissue hypoperfusion leads to

organ dysfunction and failure. Acute respiratory distress syndrome (ARDS) is a
significant sequela of severe sepsis and one that results in mortality rates that
approach 50%. ARDS also leads to prolonged intensive care unit (ICU) length of
stay and increased incidence of ventilator-associated pneumonia. Other
significant complications of septic shock include myocardial dysfunction, acute
renal failure and chronic dysfunction, disseminated intravascular coagulation
(DIC), and liver failure. Prolonged tissue hypoperfusion can lead to long-term
neurologic and cognitive sequelae as well.

Race

One large epidemiologic study showed that the risk of septicemia in the nonwhite
population is almost twice that of the white population, with the highest risk to
black men. Potential reasons for this include issues relating to access to health
care and increased prevalence of underlying medical conditions.

A more recent large epidemiologic study ties the increased incidence of septic
shock in the black population to increased infection rates requiring hospitalization
and increased development of organ dysfunction. Black patients with septic
shock had a higher incidence of underlying diabetes and renal disease, which
might explain the higher rates of infection. However, development of acute organ
dysfunction was independent of comorbidities. Furthermore, the incidence of
septic shock and severe invasive infection was higher in the young, healthy black
population, which suggests a possible genetic predisposition to developing septic
shock.

Sepsis - incidence

Mortality rates from sepsis vary with age from 5.6 deaths per 100,000 in infants
younger than 1 year of age to 0.5 per 100,000 age 1–4 years, and 0.1 per
100,000 age 5–14 years.

Prognosis

Prognosis can be estimated with the MEDS score. Approximately 20–35% of

patients with severe sepsis and 40–60% of patients with septic shock die within
30 days. Others die within the ensuing 6 months. Late deaths often result from
poorly controlled infection, immunosuppression, complications of intensive care,
failure of multiple organs, or the patient's underlying disease.

Prognostic stratification systems such as APACHE II indicate that factoring in the

patient's age, underlying condition, and various physiologic variables can yield
estimates of the risk of dying of severe sepsis. Of the individual covariates, the
severity of underlying disease most strongly influences the risk of dying. Septic
shock is also a strong predictor of short- and long-term mortality. Case-fatality
rates are similar for culture-positive and culture-negative severe sepsis.

Some patients may experience severe long term cognitive decline following an
episode of severe sepsis, but the absence of baseline neuropsychological data in
most sepsis patients makes the incidence of this difficult to quantify or to study. A
preliminary study of nine patients with septic shock showed abnormalities in
seven patients by MRI.