Shock epidemiology and outcomes among internal medicine patients
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Abstract
Background. Shock, characterised by circulatory hypoperfusion and cellular hypoxia, represents a critical medical condition requiring immediate attention. Despite its significance, there are limited data on shock incidence and outcomes, particularly within the context of Thailand.
Objectives. This retrospective observational study aimed to investigate the incidence, management and outcomes of shock patients admitted to the internal medicine department of Siriraj Hospital, a referral university hospital in Bangkok, Thailand. Additionally, the study sought to identify factors associated with mortality among these patients.
Methods. Medical records of patients admitted were reviewed. Shock cases were identified based on specific diagnostic criteria, and demographic and clinical data were extracted for analysis.
Results. A total of 125 patients were included in the study, with septic shock being the most prevalent condition (40.0%), followed by cardiogenic shock (39.2%), hypovolaemic shock (18.4%) and obstructive shock (2.4%). The overall intensive care unit (ICU) admission rate was 46.7%, varying among shock types, with cardiogenic shock patients exhibiting the highest rate. The overall 28-day mortality rate was 23.7%, with septic shock patients admitted to the ICU demonstrating the highest mortality rate (50.0%). The multivariate analysis identified factors associated with mortality, including colloid resuscitation (adjusted odds ratio (aOR) 3.10 (1.08 - 8.9), p=0.036); vasopressor dose of more than 0.2 μg/kg/min (aOR 4.38 (1.39 - 13.74), p=0.011); and renal replacement therapy (aOR 3.43 (1.04 - 11.28), p=0.043).
Conclusions. This study provides significant insights into shock incidence, management and outcomes in a tertiary referral hospital in Thailand. It also highlights challenges related to ICU bed availability and identifies predictors of mortality. Early recognition and tailored interventions are crucial for improving outcomes in shock patients.
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References
1. De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010;362:779-789.
2. Su L, Ma X, Rui X, et al. Shock in China 2018 (SIC-study): A cross-sectional survey, Ann Transl Med 2021;9:1219.
3. Permpikul C, Sivakorn C, Tongyoo S. In-hospital death after septic shock reversal: A retrospective analysis of in-hospital death among septic shock survivors at Thailand’s largest national tertiary referral center. Am J Trop Med Hyg 2021;104:395-402.
4. Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019 - results from a systematic review and meta-analysis. Crit Care 2020;24:239.
5. Vahdatpour C, Collins D, Goldberg S. Cardiogenic shock. J Am Heart Assoc 2019;8:e011991.
6. Bloom JE, Andrew E, Dawson LP, et al. Incidence and outcomes of nontraumatic shock in adults
using emergency medical services in Victoria, Australia. JAMA Netw Open 2022;5:e2145179.
7. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for
Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-810.
8. Lee JM, Rhee TM, Hahn JY, et al. Multivessel percutaneous coronary intervention in patients
with ST-segment elevation myocardial infarction with cardiogenic shock. J Am Coll Cardiol
2018;71:844-856.
9. Hochman JS, Sleeper LA, Webb JG, et al. Early revascularisation in acute myocardial infarction
complicated by cardiogenic shock. Shock investigators. Should we emergently revascularise
occluded coronaries for cardiogenic shock? N Engl J Med 1999;341:625-634.
10. Vincent JL, De Backer D. Circulatory shock. N Engl J Med 2013;369:1726-1734.
11. Phungoen P, Piyapaisarn S, Ienghong K, Kotruchin P, Mitsungnern T, Apiratwarakul K. Shock in
the emergency department: Incidence, etiology, and mortality. J Med Assoc Thailand 2020;103.
12. Tancharoen L, Pairattanakorn P, Thamlikitkul V, Angkasekwinai N. Epidemiology and burden of sepsis at Thailand’s largest university-based national tertiary referral center during 2019.
Antibiotics (Basel) 2022;11.
13. Maluangnon C, Kanogpotjananont P, Tongyoo S. Comparing outcomes of critically ill patients in
intensive care units and general wards: A comprehensive analysis. Int J Gen Med 2023;16:3779-3787.
14. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Early use of norepinephrine in septic shock resuscitation (CENSER). A randomised trial. Am J Respir Crit Care Med 2019;199:1097-1105.
15. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47:1181-1247.
16. Russell JA. Vasopressor therapy in critically ill patients with shock. Intensive Care Med 2019;45:1503-1517.
17. Bloom JE, Chan W, Kaye DM, Stub D. State of shock: Contemporary vasopressor and inotrope use in cardiogenic shock. J Am Heart Assoc 2023;12:e029787.
18. Gupta B, Garg N, Ramachandran R. Vasopressors: Do they have any role in hemorrhagic shock? J Anaesthesiol Clin Pharmacol 2017;33:3-8.
19. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247-2256.
20. Sviri S, Hashoul J, Stav I, van Heerden PV. Does high-dose vasopressor therapy in medical intensive care patients indicate what we already suspect?, J Crit Care 2014;29:157-160.
21. Tongyoo S, Tanyalakmara T, Naorungroj T, Promsin P, Permpikul C. The association of high dose vasopressor and delayed vasopressor titration with 28-day mortality in adult patients with septic shock. J Health Sci Med Res 2022;41:2022886.
22. Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: The multinational AKI-EPI study. Intensive Care Med 2015;41:1411-1423.
23. Nisula S, Kaukonen KM, Vaara ST, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: The FINNAKI study. Intensive Care Med 2013;39:420-428.
24. Elseviers MM, Lins RL, Van der Niepen P, et al. Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury, Crit Care 2010;14:R221.