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. 2016 Dec 7:6:38361.
doi: 10.1038/srep38361.

Incidence, risk factors and impact on outcomes of secondary infection in patients with septic shock: an 8-year retrospective study

Guang-Ju Zhao  1 , Dong Li  1 , Qian Zhao  1 , Jia-Xing Song  1 , Xiao-Rong Chen  1 , Guang-Liang Hong  1 , Meng-Fang Li  1 , Bing Wu  1 , Zhong-Qiu Lu  1
Affiliations

Incidence, risk factors and impact on outcomes of secondary infection in patients with septic shock: an 8-year retrospective study

Guang-Ju Zhao et al. Sci Rep. .

Abstract

Secondary infection in septic patients has received widespread attention, although clinical data are still lacking. The present study was performed on 476 patients with septic shock. Time trends for mortality were analyzed using Spearman's rank correlation test. Risk factors for secondary infection were investigated by binary logistic regression. The extended Cox model with time-varying covariates and hazard ratios (HR) was performed to determine the impact of secondary infection on mortality. Differences in hospital length of stay (LOS) between patients with and without secondary infection were calculated using a multistate model. Thirty-nine percent of septic shock patients who survived the early phase of the disease developed secondary infection. There was a statistically significant increased odds ratio for secondary infection in older patients and patients with a longer LOS in the intensive care unit (ICU), a higher Sequential Organ Failure Assessment (SOFA) score, and endotracheal intubation. Secondary infection significantly reduced the rate of discharge (HR 5.607; CI95 3.612-8.704; P < 0.001) and was associated with an increased hospital LOS of 5.46 days. The present findings represent a direct description of secondary infection in septic shock patients and highlight the influence of this condition on septic shock outcomes.

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Figures

Figure 1
Figure 1. A flow chart of the studied population.
A total of 476 septic shock patients met the criteria and were included in the study to assess the time trends of mortality. Three hundred and seventy-two patients with an ICU LOS > 48 hours were included in the assessment of the incidence, risk factors and impact of secondary infection on outcomes. LOS: length of stay.
Figure 2
Figure 2. Time trends for total mortality as well as early and late death rates from 2008 to 2015.
Figure 3
Figure 3. Cumulative incidence functions for discharge and death.
Solid lines: discharge; dashed lines: death; read lines: secondary infection; black lines: no secondary infection. SI: secondary infection; NSI: no secondary infection.
Figure 4
Figure 4. Extra hospital length of stay in patients with (red line) and without (black line) secondary infection.
LOS: length of stay.
See this image and copyright information in PMC

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