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Impact de l'identification précoce de la porte d'entrée du choc septique sur les défaillances d'organes

Year: 2024
Type: dissertation
Study design: Observational Study
Abstract: Introduction: Septic shock accounts for 10 to 15% of ICU admissions and is a major cause of morbidity and mortality. Early identification of the source of septic shock is essential for optimizing management and improving prognosis. However, the actual impact of this rapid identification on organ failures remains to be demonstrated. The objective of the study was to determine whether knowledge of the source upon admission influenced the SOFA score and other morbidity and mortality criteria, particularly in cirrhotic patients. Material and method: This retrospective monocentric study, conducted at the CHU of Amiens, included 144 patients admitted to the ICU in 2022 for suspected septic shock. Patients were divided into two groups: those with a confirmed source and those with an uncertain source at admission. The primary outcome was an increase of at least 2 points in the SOFA score between ICU admission and the third day of treatment. Results: Of the 144 patients, 113 had a confirmed source, while 31 had an uncertain source. No significant difference was observed regarding the worsening of the SOFA score at 72 hours (p > 0.05). However, advanced age (>80 years), COPD, and a high SOFA score at admission were associated with worsening organ failures. Among cirrhotic patients, the SOFA score increased more often when the source was unknown. Discussion: The lack of a significant association between an unknown source and the worsening of organ failures may be explained by standardized management or by the limitations of the SOFA score. However, in cirrhotic patients, an unknown source seems to be associated with a worse prognosis, suggesting a need for more diagnostic investigations in this population. Conclusion: The lack of knowledge of the source of septic shock at admission does not worsen the SOFA score on day 3.
Source: HAL
Author: Tobaly, Yohan
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W6982446944
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