Preventing Death from Septic Shock in Patients with Cirrhosis

Septic shock is a major cause of admission to intensive care units among patients with cirrhosis, which results in significant morbidity, mortality, and cost. Early administration of appropriate antimicrobials and combination regimens are suggested as practice-related factors that might improve survival in this group. To investigate this issue, researchers identified 635 adult patients with septic shock and cirrhosis in a database from 28 medical centers in the U.S., Canada, and Saudi Arabia and examined relationships between factors related to delivery of antimicrobial therapy and hospital mortality.

The mean age of the cohort was 56 years, and the mean model for end-stage liver disease score was 26.7. Hospital mortality was 75.6%. Inappropriate initial antimicrobial therapy was administered in 24.4% of patients and was associated with increased risk for mortality (adjusted odds ratio, 9.5; 95% confidence interval, 4.3–20.7). A delay in administration of appropriate antimicrobial therapy was also associated with an increased risk for mortality (adjusted OR for each hour of delay, 1.1; 95% CI, 1.1–1.2). Finally, 72.9% of patients with bacterial septic shock received only a single antibiotic agent, which was associated with an increased risk for mortality compared with receipt of ≥2 agents (adjusted OR, 1.8; 95% CI 1.0–3.3).