Ann Geriatr Med Res 2017; 21(4): 168-173  http://dx.doi.org/10.4235/agmr.2017.21.4.168
Prognostic Factors in Septic Shock Patients on Arrival at Emergency Department
Seong Yeob Lee1, Jin Joo Kim1, Jae Ho Jang1, In Cheol Hwang2
1Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, 2Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
Correspondence to: Jin Joo Kim, MD, PhD
Department of Emergency Medicine, Gachon University Gil Medical Center, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea
Tel: +82-32-460-3015
Fax:+82-32-460-3019
E-mail: empearl@gilhospital.com
Co-corresponding Author: In Cheol Hwang, MD, PhD
Department of Family Medicine, Gachon University Gil Medical Center, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea
Tel: +82-32-460-3354
Fax:+82-32-460-3019
E-mail: spfe0211@gmail.com
Received: September 22, 2017; Revised: October 27, 2017; Accepted: October 27, 2017; Published online: December 31, 2017.
© The Korea Geriatrics Society. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: In this study, we evaluated the prognostic factors in patients with septic shock who were managed at an Emergency Department (ED).
Methods: This retrospective study was conducted through a chart review of the emergency medical records of all patients with septic shock who were over 18 years of age and managed and hospitalized in the ED from January 2008 to September 2014 at 1 regional emergency center in South Korea. The outcome sought was mortality at 30 days after ED arrival.
Results: Of the 648 patients admitted to the ED during the study period, 187 patients (28.9%) died. Factors associated with 30-day mortality in a multiple logistic regression analysis were elderly patients (〉70 years), acute physiology and chronic health evaluation II, leukopenia (white blood cell count〈4,000/mm3), prolonged international normalized ratio above 1.2, hypoxemia (pO2〈83 mmHg), lactate level (〉4.0 mmol/L), pneumonia-related sepsis, and history of tuberculosis, respectively.
Conclusion: An age of over 70 years was related to mortality in septic shock; however, other various laboratory results and biomarkers were also related to mortality and some factors even demonstrated a stronger relationship than age. Treatment should not be limited among elderly septic shock patients due to an ED physician’s prejudice. Instead, ED physicians should make decisions regarding the care of septic shock patients by considering various factors including unstable clinical signs, laboratory findings, lactate, and source of infection, in addition to the patient’s age, in order to produce better outcomes.
Keywords: Prognosis, Septic shock, Frail elderly, Biomarkers, Emergency Department


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