Outcomes of patients undergoing early sepsis resuscitation for cryptic shock compared with overt shock

Michael A. Puskarich, Stephen Trzeciak, Nathan I. Shapiro, Alan C. Heffner, Jeffrey A. Kline, Alan E. Jones

Research output: Contribution to journalArticlepeer-review

89 Scopus citations

Abstract

Introduction: We sought to compare the outcomes of patients with cryptic versus overt shock treated with an emergency department (ED) based early sepsis resuscitation protocol. Methods: Pre-planned secondary analysis of a large, multicenter ED-based randomized controlled trial of early sepsis resuscitation. All subjects were treated with a quantitative resuscitation protocol in the ED targeting 3 physiological variables: central venous pressure, mean arterial pressure and either central venous oxygen saturation or lactate clearance. The study protocol was continued until all endpoints were achieved or a maximum of 6. h. Outcomes data of patients who were enrolled with a lactate ≥4. mmol/L and normotension (cryptic shock) were compared to those enrolled with sustained hypotension after fluid challenge (overt shock). The primary outcome was in-hospital mortality. Results: A total of 300 subjects were enrolled, 53 in the cryptic shock group and 247 in the overt shock group. The demographics and baseline characteristics were similar between the groups. The primary endpoint of in-hospital mortality was observed in 11/53 (20%, 95% CI 11-34) in the cryptic shock group and 48/247 (19%, 95% CI 15-25) in the overt shock group, difference of 1% (95% CI -10 to 14; log rank test p=0.81). Conclusion: Severe sepsis with cryptic shock carries a mortality rate not significantly different from that of overt septic shock. These data suggest the need for early aggressive screening for and treatment of patients with an elevated serum lactate in the absence of hypotension.

Original languageEnglish (US)
Pages (from-to)1289-1293
Number of pages5
JournalResuscitation
Volume82
Issue number10
DOIs
StatePublished - Oct 2011
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by grant K23GM076652 (Jones) from the National Institute of General Medical Sciences/National Institutes of Health . Dr Puskarich has salary support by grant 10POST3560001 from the American Heart Association . Dr. Trzeciak is supported by grant GM083211 from the National Institute of General Medical Sciences/National Institutes of Health . Dr Shapiro was supported by grants HL091757 and GM076659 from the NIH . The sponsors had no role in the collection, analysis, or interpretation of the study data, nor in the writing of the manuscript.

Keywords

  • Lactate
  • Mortality
  • Resuscitation
  • Sepsis
  • Septic shock

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