Predictors of Septic Shock Mortality at a Tertiary Hospital in Ethiopia: A Prospective Observational Study

Predictors of Septic Shock Mortality at a Tertiary Hospital in Ethiopia: A Prospective Observational Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictors of Septic Shock Mortality at a Tertiary Hospital in Ethiopia: A Prospective Observational Study Amanuel Zeleke, Alazar Sitotaw, Balew Arega, Elias Tewabe, Gashaw Solela, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4214041/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Septic shock causes significant mortality, ranging from 30% to 50%, with a slight difference in developing and developed countries. There is insufficient evidence in Ethiopia regarding septic shock mortality. Therefore, we aimed to determine the in-hospital mortality rate and its predictors among septic shock patients admitted to a tertiary hospital in Ethiopia. Methods: A hospital-based prospective observational study was conducted among septic shock patients admitted to Yekatit 12 Hospital Medical College (Y12HMC) from January to September 2023. All patients with septic shock who fulfilled the inclusion criteria were included and followed until discharge or death. We collected sociodemographic characteristics, clinical and laboratory parameters, microbiologic findings, and treatment-related data from eligible patients using a standardized data extraction format. Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) version 25. The multivariable analysis using the Cox regression model was used to determine the predictors of in-hospital mortality, with P < 0.05 representing statistical significance. Results: A total of 144 septic shock patients were included in the study. The mean age was 46 ± 19 years, with a range of 15 to 95 years. The overall in-hospital mortality of septic shock patients was 66.7%. The multivariable Cox regression analysis revealed that low Glasgow coma scale (GCS) [adjusted hazard ratio: 2.23, 95% CI: 1.35-3.69, P = 0.01] and low peripheral oxygen saturation (SpO2) [adjusted hazard ratio: 8.74, 95% CI: 1.18-14.84, P = 0.03] at diagnosis were independently associated with a higher risk of in-hospital mortality. Conclusion: Septic shock mortality was found significantly higher in our study. Septic shock patients with low GCS and SpO2 at the time of diagnosis require a vigilant care. Early identification of high-risk patients, applying appropriate and compressive management could reduce the mortality. Septic shock Predictors In-hospital mortality Ethiopia Figures Figure 1 Figure 2 Background Septic shock is a major health care problem, impacting millions of people around the world each year and killing between one in three and one in six of those it affects [1, 2]. The incidence of septic shock is increasing on a global scale. It has become one of the frequent reasons for intensive care unit (ICU) admissions and the leading cause of death in critically ill patient [2, 3]. Despite advances in recognition and treatment of septic shock, its in-hospital mortality remains alarmingly high, with rates ranging from 30% to 50% according to recent studies [4, 5]. In Ethiopia, prior studies showed a high level of septic shock mortality rate with 53.8% at Tikur Anbessa Specialized Hospital [2] and 42% at the University of Gondar Hospital [5]. Both of these studies were retrospective in nature and had a small sample size. Hence, the results of these studies can be affected by incompleteness of data and lack of generalization to the general population. The in-hospital mortality rate of septic shock patients is potentially affected by the presence of comorbidities, early guideline-based treatment, local antimicrobial resistance, and the availability of human expert [1, 5]. This indicates that local factors determine the magnitude of septic shock morality and identifying specific factors associated with poor outcomes enables clinicians to practice evidence-based medicine and to improve patients' outcomes. In this study, we investigated in-hospital mortality of septic shock and its predictors in the context of Ethiopia. The results would help the clinical and administrative personnel in the hospital care of septic shock patients with a consequent mortality reduction. In addition, it would be used as an evidence to develop hospital-based protocols and national guidelines to address the burden of the problem in the country. Methods Study setting, design, and period A hospital-based prospective observational study was conducted from January to September 2023 among septic shock patients admitted to Yekatit 12 Hospital Medical College, a teaching hospital in Addis Ababa, Ethiopia. It is one of the largest hospitals in the country, with over 500 beds, treating approximately 310,000 patients each year, and having 21 departments and units. The hospital has a ten-bed adult ICU that serves about 350 to 400 adult patients per year. Study population and variables The study included septic shock patients (age ≥ 15 years old) admitted to the adult ICU. We used Sepsis-3 definition to screen sepsis patients using systemic inflammatory response syndrome (SIRS) and/or sequential organ failure assessment (SOFA) criteria. Those sepsis patients who required vasopressor to keep systolic blood pressure (SBP) ≥100 mmHg despite adequate fluid resuscitation were diagnosed to have septic shock. Patients with other types of shock and any form of cardiac problem(s) were excluded. We followed patients from admission to discharge to determine the outcome (mortality). The number of septic shock deaths divided by the total number of septic shock patients yielded the mortality rate. Data collection procedure, tools, and data quality control We obtained an ethical approval from the Y12HMC (protocol number: 314/23) and informed consent from the patients. Trained internal medicine residents collected both the primary and secondary data. Sociodemographic and behavioral characteristics were collected by interviews with the patients and/or their caregivers. The clinical parameters, primary focus of infection, comorbidities, complications, laboratory and management-related factors were extracted from the electronic medical records of the patients. The data collection process was supervised and monitored by the principal investigator. We rechecked the collected data daily for completeness and consistency. Statistical analysis SPSS version 25 was used for data entry and analysis. The entered data were cleaned and checked for consistency. Descriptive statistics were used to calculate frequency, percentage, mean, and ranges. Bivariable and multivariable analyses using the Cox regression model were used to identify predictors of septic shock mortality. A hazard ratio with a 95% confidence interval was used to determine the strength of association between the outcome variable and the independent variables. P- values < 0.05 were considered as statistically significant. The incidence of mortality during the hospital stays was presented using the Kaplan-Meier curve. Results Sociodemographic characteristics One hundred forty-four septic shock patients were found to be eligible and included in the study with a response rate of 100%. The mean age was 46 ± 19 years with a range of 15 to 95 years. The majority of patients (55.6%) were males. Approximately, one-third (30%) of the patients had recent admission in the past 3 months. However, it was difficult to specify the type of drug(s) that were taken by patients before the current admission. Table 1: Sociodemographic characteristics of septic shock patients at Y12HMC from January to September 2023 (N=144) Clinical characteristics Around 93% to 98% of patients had abnormal body temperature, respiratory rate, heart rate, white cell counts and peripheral oxygen saturation which were consistent with the SIRS and/or SOFA criteria. Altered mental status, elevated creatinine and mild to severe thrombocytopenia were also found in 50% to 60% of patients. An abnormal total bilirubin was only seen in 14.6% of the cases. Table 2: Clinical and laboratory parameters of septic shock at Y12HMC from January to September 2023 (N=144) Comorbidities Nearly, two-third of the patients (68%) had one or more comorbidities. The most common comorbidity was human immunodeficiency virus (18.8%) followed by diabetes mellitus (17.4%) and chronic lung disease (14.6%). After admission, five patients had developed venous thromboembolism (VTE) and three cases of tuberculosis-associated sepsis were diagnosed with sputum gene xpert and/or urine lipoarabinomannan (LAM). Table 3: Comorbidities of septic shock patients at Y12HMC from January to September 2023 (N=144) Focus of infection and sepsis related organ dysfunction Pulmonary infection was identified in about 70% of the patients followed by gastrointestinal (34.7%) and central nervous system (10.4%) infections. Twenty cases (13.9%) had wound, genitourinary and skin/soft tissue infections. None of the participants had catheter-associated blood stream infection, IV site or other focus of infection. Most of the patients (90%) had developed one or more sepsis related organ dysfunctions. The commonest identified complications were electrolyte disorders (63.9%) acute kidney injury (51.4%) and acute respiratory failure (50.7%). One-third of the patients were complicated with mild to severe thrombocytopenia. Table 4: Infection focuses and complications of septic shock at Y12HMC from January to September 2023 (N=144) Microbiologic evidences Blood culture was done for a total of 83 (57.6%) patients and it was done twice for less than one-third of the patients. A sample for culture was taken before antimicrobial administration in 78 (94%) patients. Only seven blood culture results were found to be positive of which four revealed gram-negative isolates and three revealed gram-positive isolates. The available antimicrobials for the sensitivity test were amoxicillin-clavulanic acid, ceftriaxone, ceftazidime, cefepime, ciprofloxacin, clindamycin, cotrimoxazole, erythromycin, gentamycin, meropenem and vancomycin. Antimicrobials were revised based on the culture results. Gene xpert/urine LAM were done for 14 patients of which only three were positive. Table 5: Blood culture results of septic shock patients at Y12HMC from January to September 2023 (N=144) Figure 1 : Bacterial isolates from septic shock patients at Y12HMC from January to September 2023 Treatment modalities All patients were given crystalloid fluid, antimicrobials and vasopressors. For almost all cases (95%), antimicrobials were initiated within the first 3 hours of diagnosis. The three commonly utilized antimicrobials were vancomycin (97.9%), ceftazidime (51.4%) and cefepime (30%). The first widely used vasopressor was adrenaline (70%) followed by noradrenaline (27.8%). Eighteen (12.5%) and ninety-three (64.6%) patients had required second vasopressor and hydrocortisone for refractory septic shock, respectively. None of them had taken dobutamine. All treatment modalities were administered via peripheral intravenous access. Table 6: Vasopressors and antimicrobials utilization for septic shock at Y12HMC from January to September 2023 (N=144) In-hospital mortality rate of septic shock and length of hospital stay The overall in-hospital mortality rate of septic shock patient was 66.7%. The median length of hospital stay was 6 days (IQR: 2-11 days). The minimum and maximum length of hospital stay was ranged from 1 to 49 days. Many deaths occurred in the first 10 days of admission. Half of the total cases died within the first three weeks of admission. Figure 2: Kaplan-Meier curve of septic shock mortality at Y12HMC from January to September 2023 Predictors of septic shock in-hospital mortality Bivariable Cox regression analysis showed that low GCS (CHR: 1.84, 95% CI, 1.19-2.86, P = 0.01) and low SpO2 (CHR: 5.24, 95% CI: 4.73-37.73, P = 0.05) at the time of diagnosis; acute respiratory failure (CHR: 1.52, 95% CI: 1.22-2.32, P = 0.04) were significantly associated with an increased risk of septic shock in-hospital mortality. The multivariable Cox regression analysis revealed that low GCS (AHR: 2.23, 95% CI: 1.35-3.69, P = 0.01) and low SpO2 (AHR: 8.74, 95% CI: 1.18-14.84, P = 0.03) at the time of diagnosis were independently associated with a greater risk of septic shock in-hospital mortality. The relative risk of death in patients who had low GCS and SpO2 was likely 2 and 8 times higher compared to those who had normal GCS and SpO2 at the time of diagnosis, respectively. Table 7: Bivariable and multivariable analysis of septic shock patients at Y12HMC from January to September 2023 Discussion The main objective of this study was to provide representative data on the predictors of septic shock outcomes in Ethiopia. The study found that the overall in-hospital mortality of septic shock was 66.7%. The multivariable analysis using the Cox regression analysis demonstrated that low GCS and low peripheral oxygen saturation at the time of diagnosis were independent determinants of septic shock in-hospital mortality. In this study, the overall in-hospital mortality of septic shock is very high compared to the recent literatures published in Europe [6, 7]. Our finding is also higher than the reports in other tertiary hospitals in Ethiopia such as Tikur Anbessa Specialized Hospital (58.3%) [2] and University of Gondar Hospital (42%) [5]. This can be partly explained by the absence of infectious disease, and pulmonary and critical care Sub-specialists. Besides, the absence of well-customized hospital-based protocols for early identification and management of septic shock may contribute to higher mortality. In addition to limited knowledge and resources, septic shock mortality in Sub-Saharan Africa is believed to be disproportionately high due to widespread malnutrition, sub-optimally managed comorbidities and higher rates of infectious diseases including HIV and TB [4, 5, 8, 9]. Around 68% of patients had one or more comorbidities and HIV was found in 18.8% of the cases in our study. This is consistent with many studies which may contribute to the high mortality [2, 4-6, 8, 10]. Factors affecting in-hospital mortality in septic shock patients remain uncertain [5, 10, 11]. Several studies [6, 7, 12-17] have shown that the presence of one or more comorbidities, focuses of infection, organ failures and initial severity of septic shock (higher SIRS/SOFA scores) negatively affect septic shock outcome. In our study, altered mental status and low levels of peripheral oxygen saturation at the time of diagnosis were significantly associated with a greater risk of septic shock in-hospital mortality. Altered mentation for several reasons on its own is associated with worse patient outcome and doubles the poor prognosis in these patients. Sepsis-associated encephalopathy is related to increased short-term mortality in patients with septic shock [8, 16, 18-19]. Likewise, low oxygenation in patients with septic shock was also associated with a higher organ dysfunctions and death [3]. The respiratory tract was the leading primary source of infection in 70% of cases followed by the gastrointestinal tract (34.7%). This finding is consistent with most studies conducted in both developed and developing nation [2, 4, 17]. In our study, 10.4% of the cases had a clinical diagnosis of meningitis leading to septic shock. Several case reports and case series provide supports that bacterial meningitis continues to be a relevant cause of septic shock [1, 18-19]. In this study, neither respiratory tract nor CNS focuses were associated with septic shock mortality. Unlike other studies, none of the participants developed catheter-associated blood stream and IV site infections [10]. The reasons to the later findings are probably related to the difference in the study population. Electrolyte disorders (these included low or high levels of serum sodium, potassium, calcium and/or magnesium) were the most common complications in this study. Some of the explanations are pulmonary and CNS infections can cause hyponatremia due to the syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and gastrointestinal sepsis can result in the loss of one or more electrolytes. We noted that respiratory and gastrointestinal tracts were the common focuses of sepsis in our study, which can explain the presence of one or more electrolyte disorders. Compared to studies conducted in the USA and Europe where septic shock tends to occur more in the elderly [3, 6, 12], this study found that all age groups were affected proportionally. This difference can be due to a longer life expectancy in the developed nations where elderly individuals were affected more likely. On the other hand, a dramatically increased prevalence of non-communicable diseases in addition to the high burden of communicable diseases affecting the young and middle-aged population in this setting may explain our findings. In line with several literatures [2, 3, 5-6], more than half of the cases had one or more comorbidities and 90% of the total patients developed one or more organ dysfunction(s) in this study. In our study, 64.6% of patients received corticosteroids and it indirectly indicates the burden of refractory septic shock not responding to fluid and vasopressor therapy alone. Literatures showed that steroid use has not any mortality benefit but it has shown to provide better hemodynamic response in patients with septic shock [5]. Thus, the role of steroids in septic shock is limited only to refractory cases of fluid and vasopressor therapy. Similar to studies done by Shibiru et al [5]; this study showed no statistical difference in mortality regarding the type of vasopressor and steroid utilized. However, it is difficult to conclude without controlling the effect of other treatment-related factors. Some studies have shown the negative effect of delayed initiation of antimicrobial in determining the outcome of septic shock [9, 20]. This effect was absent in our study probably because that antimicrobials were initiated within the first 3 hours of diagnosis nearly for all cases (95%) in line with the 3-hour sepsis bundle. Compared to other hospitals [1, 4, 17], the culture yield was very low (around 10%) in this study. As our study participants were septic shock patients, the treatment should be guided by the local culture and sensitivity results. We evaluated the outcome of septic shock patients by prospective observational study design using comprehensive and multidimensional parameters. It is also the first study carried out in our hospital that identified predictors of poor septic shock outcomes. However, the study was a single-centered with a relatively small sample size. Conclusion Septic shock has a higher mortality at a teaching hospital in Ethiopia, where nearly two-third of the patients died. Septic shock patients had more comorbidities, multiple sepsis- related organ dysfunctions and multiple focuses of infection causing death. Low levels of the Glasgow coma scale and peripheral oxygen saturation at the time of diagnosis were the independent predictors associated with a higher risk of in-hospital mortality in our study. Strategies (e.g. a facilitated referral system) shall be paved to let patients with septic shock visit health facilities early. Prompt recognition and early goal-directed therapy is essential for a better outcome. The microbiology unit has to use advanced technologies, guided by national and international recommendations for sample collection and screening to increase the yield of the culture. This allows the treating Physicians to revise the antimicrobials based on the culture results. Abbreviations CONS: Coagulase negative staphylococcus DHS: Demographic and health survey EGDT: Early goal directed therapy GCS: Glasgow coma scale mmHg: Millimeter mercury SpO2: Peripheral oxygen saturation SLE: Systemic lupus erythematous VTE: Venous thromboembolism Declarations Ethical approval and consent to participate We obtained ethical approval from the Yekatit 12 Hospital Medical College Ethical Review Committee. Written informed consent was taken from the patients and/or caregivers. Consent for publication Not applicable Availability of data and materials The data sets used and analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no any competing interests. Funding This research has no received funding support. Author’s contributions AZ, AM, GE, and ETS contributed to the study design and data collection tool. AS and HT were involved in data collection. HH and SL entered the data. AZ, ETA, SA, and SH analyzed and interpreted the data. AZ, BA, GS, SBG, and AE involved in the final writing of the manuscript. All authors read and approved the final paper. Acknowledgement No special acknowledgement References Octora M, Mertaniasih NM, Semedi BP, Koendhori EB. Predictive Score Model of Clinical Outcomes Sepsis in Intensive Care Unit Tertier Referral Hospital of Eastern Indonesia. Open Access Maced J Med Sci. 2021;9 Apache Ii:1710–6. Teklemichael H. Assessment of the Incidence and Treatment Outcome of Septic Shock Among Patients Admitted Adult To Intensive Care Unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. 2017. Carrara M, Baselli G, Ferrario M. Mortality Prediction Model of Septic Shock Patients Based on Routinely Recorded Data. Comput Math Methods Med. 2015;2015. Mulatu HA, Bayisa T, Worku Y, Lazarus JJ, Woldeyes E, Bacha D, et al. Prevalence and outcome of sepsis and septic shock in intensive care units in Addis Ababa, Ethiopia: A prospective observational study. African J Emerg Med. 2021;11:188–95. Shibru H, Muhie OA, Yesuf T, Shenkutie Greffie E, Mitiku T, Admasu Z, et al. Outcome of Septic Shock and Associated Factors at the University of Gondar Hospital: A Retrospective Cohort Study. J Intensive Crit Care. 2020;6:1–7. Daviaud F, Grimaldi D, Dechartres A, Charpentier J, Geri G, Marin N, et al. Timing and causes of death in septic shock. Ann Intensive Care. 2015;5. Song JE, Kim MH, Jeong WY, Jung IY, Oh DH, Kim YC, et al. Mortality risk factors for patients with septic shock after implementation of the surviving sepsis campaign bundles. Infect Chemother. 2016;48:199–208. Hopkinson DA, Mvukiyehe JP, Jayaraman SP, Syed AA, Dworkin MS, Mucyo W, et al. Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality. PLoS One. 2021;16 5 May 2021:1–15. Puchalski Ritchie LM, Beza L, Debebe F, Wubetie A, Gamble K, Lebovic G, et al. Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis. Implement Sci. 2022;17:1–14. Leedahl DD, Personett HA, Gajic O, Kashyap R, Schramm GE. Predictors of mortality among bacteremic patients with septic shock receiving appropriate antimicrobial therapy. BMC Anesthesiol. 2014;14. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. Jama. 2014;311:1308–16. Chen S, Gao Z, Hu L, Zuo Y, Fu Y, Wei M, et al. Association of Septic Shock with Mortality in Hospitalized COVID-19 Patients in Wuhan, China. Adv Virol. 2022;2022. Lissalde-Lavigne G, Combescure C, Muller L, Bengler C, Raillard A, Lefrant JY, et al. Simple coagulation tests improve survival prediction in patients with septic shock. J Thromb Haemost. 2008;6:645–53. Hagiwara A, Tanaka N, Inaba Y, Gando S, Shiraishi A, Saitoh D, et al. Predictors of severe sepsis-related in-hospital mortality based on a multicenter cohort study. Medicine (Baltimore). 2021;100:e24844. Vucelić V, Klobučar I, Đuras-Cuculić B, Grginić AG, Prohaska-Potočnik C, Jajić I, et al. Sepsis and septic shock – an observational study of the incidence, management, and mortality predictors in a medical intensive care unit. Croat Med J. 2021;61:429–39. Yang Y, Liang S, Geng J, Wang Q, Wang P, Cao Y, et al. Development of a nomogram to predict 30-day mortality of patients with sepsis-associated encephalopathy: A retrospective cohort study. J Intensive Care. 2020;8:1–12. Ramzi J, Mohamed Z, Yosr B, Karima K, Raihane B, Lamia A, et al. Predictive factors of septic shock and mortality in neutropenic patients. Hematology. 2007;12:543–8. Dienstmann G, Avi KT, Leite LAC, Alano JS, Souza MLR de, Mulazani M da S, et al. First case report of fulminant septic shock from meningococcemia associated with Cryptococcus neoformans coinfection in an immunocompetent patient. Med Mycol Case Rep. 2019;26 September:44–6. Pota V, Passavanti MB, Coppolino F, Di Zazzo F, De Nardis L, Esposito R, et al. Septic shock due to Escherichia coli meningoencephalitis treated with immunoglobulin-M-enriched immunoglobulin preparation as adjuvant therapy: a case report. J Med Case Rep. 2021;15:1–8. Dugar S, Choudhary C, Duggal A. Sepsis and septic shock: Guideline-based management. Cleve Clin J Med. 2020 Jan;87(1):53-64. doi: 10.3949/ccjm.87a.18143. Epub 2020 Jan 2. PMID: 31990655 Tables Table 1: Sociodemographic characteristics of septic shock patients at Y12HMC from January to September 2023 (N=144) Characteristics Frequency (%) Survivors (%) Non-survivors (%) Sex Male 80 (55.6) 29 (20.1) 51 (35.4) Female 64 (44.4) 19 (13.2) 45 (31.3) Age a 15-24 22 (15.3) 9 (6.3) 13 (9.0) 25-34 22 (15.3) 11(7.6) 11 (7.6) 35-44 28 (19.4) 9 (6.3) 19 (13.2) 45-54 28 (19.4) 7 (4.9) 21 (14.6) 55-64 18 (12.5) 7 (4.9) 11 (7.6) ≥65 26 (18.1) 5 (3.5) 21 (14.6) Residence A.A Bole sub-city 31 (21.5) 5 (3.5) 26 (18.1) A.A Arada sub-city 20 (13.9) 8 (5.6) 12 (8.3) A.A Yeka sub-city 20 (13.9) 7 (4.9) 13 (9.0) A.A Lemi Kura sub-city 15 (10.4) 6 (4.2) 9 (6.3) Others b 58 (40.3) 22 (15.3) 46 (31.9) a Ethiopian demographic and health survey (EDHS) age category, A.A: Addis Ababa b Amhara region, Oromia region, South nations, nationalities and peoples region, other sub-cities of Addis Ababa (Kirkos, Gulele, Addis Ketema, Lideta, Lafto, Kaliti, Nifas Silk) Table 2: Clinical and laboratory parameters of septic shock at Y12HMC from January to September 2023 (N=144) Clinical variables Overall frequency (%) Survivors (%) Non-survivors (%) Focus of infection Respiratory tract 101 (70.2) 27 (18.8) 74 (51.4) Gastrointestinal tract 50 (34.7) 18 (12.5) 32 (22.2) Central nervous system 15 (10.4) 1 (0.7) 14 (9.7) Wound 13 (9.0) 3 (2.1) 10 (6.9) Genitourinary tract 6 (4.2) 3 (2.1) 3 (2.1) Skin/soft tissue 1 (0.7) 0 (0.0) 1 (0.7) One focus 104 (72.2) 43 (29.9) 61 (42.4) Multiple focuses 40 (27.8) 5 (3.5) 35 (24.3) Organ dysfunction Electrolyte disorder 92 (63.9) 25 (17.4) 67 (46.5) Acute kidney injury 74 (51.4) 25 (17.4) 49 (34.0) Respiratory failure 73 (50.7) 11 (7.6) 62 (43.1) Thrombocytopenia 42 (29.2) 14 (9.7) 28 (19.4) Acute brain failure 27 (18.8) 2 (1.4) 25 (17.4) Acute liver injury 17 (11.8) 5 (3.5) 12 (8.3) Metabolic disorder 17 (11.8) 4 (2.8) 13 (9.0) Arrhythmia 16 (11.1) 2 (1.4) 14 (9.7) No organ failure 14 (9.7) 6 (4.2) 8 (5.6) One organ failure 35 (24.3) 15 (10.4) 20 (13.9) Multi-organ failure 95 (66.0) 27 (18.8) 68 (47.2) Table 3: Comorbidities of septic shock patients at Y12HMC from January to September 2023 (N=144) Predictors of in-hospital mortality CHR 95% CI for CHR P -value AHR 95% CI for AHR P -value GCS 1.84 1.19-2.86 0.01 2.23 1.35-3.69 0.01 SpO2 5.24 4.71-7.73 0.05 8.74 1.18-14.84 0.03 Respiratory failure 1.52 1.22-2.32 0.04 1.44 0.88-2.37 0.14 CHR : Crude hazard ratio AHR : Adjusted hazard ratio CI : Confidence interval Table 4: Infection focuses and complications of septic shock at Y12HMC from January to September 2023 (N=144) SIRS/SOFA criteria at the time of diagnosis Frequency a (%) Survivors (%) Non-survivors (%) Systolic blood pressure ≤ 100 mmHg 144 (100) 48 (33.3) 96 (66.7) Respiratory rate > 20 breaths per minute 141 (97.9) 45 (31.3) 96 (66.7) Heart rate > 90 beats per minute 140 (97.2) 46 (31.9) 94 (65.3) Temperature 38 ºC 135 (93.7) 45 (31.3) 90 (62.5) White cell count 12*10 3 cells/ul 135 (93.7) 46 (31.9) 89 (61.8) Peripheral oxygen saturation < 90% 134 (93.1) 39 (27.1) 95 (65.9) Glasgow coma scale < 15 82 (56.9) 15 (10.4) 67 (46.5) Creatinine ≥ 1.2 mg/dl 74 (51.4) 27 (18.8) 47 (32.6) Platelets ≤ 150*10 3 cells/ul 69 (47.9) 22 (15.3) 47 (32.6) Total bilirubin ≥ 1.2 mg/dl 21 (14.6) 10 (6.9) 11 (7.6) a Frequency of septic shock patients who had the specific SIRS or SOFA criteria at the time of diagnosis Table 5: Blood culture results of septic shock patients at Y12HMC from January to September 2023 (N=144) Comorbidities Frequency (%) Survivors (%) Non-survivors (%) Human immunodeficiency virus 27 (18.8) 6 (4.2) 21 (14.6) Diabetes mellitus 25 (17.4) 7 (4.9) 18 (12.5) Chronic lung disease 21 (14.6) 7 (4.9) 14 (9.7) Cancer 19 (13.2) 5 (3.5) 14 (9.7) Hypertension 16 (11.1) 9 (6.3) 7 (4.9) Stroke 9 (6.3) 4 (2.8) 5 (3.5) Chronic liver disease 8 (5.6) 1 (0.7) 7 (4.9) Chronic kidney disease 7 (4.9) 2 (1.4) 5 (3.5) Others a 14 (9.7) 3 (2.1) 11 (7.6) No comorbidity 46 (31.9) 20 (13.9) 26 (18.0) One comorbidity 67 (46.5) 17 (11.8) 50 (34.7) Multiple comorbidities 31 (21.6) 11 (7.6) 20 (13.9) a Alcohol use disorder, Alzheimer’s disease, anemia, pancreatitis, benign prostatic hyperplasia [BPH], malnutrition, Parkinson’s disease, rheumatoid arthritis, systemic lupus erythematosus [SLE] (each accounted one case), VTE (5 cases) Table 6: Vasopressors and antimicrobials utilization for septic shock at Y12HMC from January to September 2023 (N=144) Blood culture results Frequency Percent Culture done 83 57.6 One sample 60 72.3 Two sample 23 27.7 Culture positive 7 8.4 Antimicrobials utilized Frequency Percent Vancomycin 141 97.9 Ceftazidime 74 51.4 Cefepime 43 29.9 Meropenem 28 19.4 Metronidazole 23 16.0 Ceftriaxone 15 10.4 Ciprofloxacin 9 6.3 Ampicillin 6 4.2 Antimicrobial initiation <1 hour 32 22.2 1-3 hours 105 72.9 3-6 hours 7 4.9 1 st vasopressor utilized Adrenaline 101 70.1 Noradrenaline 40 27.8 Dopamine 3 2.1 2 nd vasopressor utilized 18 12.5 Dopamine 13 9.0 Adrenaline 5 3.5 Table 7: Bivariable and multivariable analysis of septic shock patients at Y12HMC from January to September 2023 Predictors of in-hospital mortality CHR 95% CI for CHR P -value AHR 95% CI for AHR P -value GCS 1.84 1.19-2.86 0.01 2.23 1.35-3.69 0.01 SpO2 5.24 4.71-7.73 0.05 8.74 1.18-14.84 0.03 Respiratory failure 1.52 1.22-2.32 0.04 1.44 0.88-2.37 0.14 CHR : Crude hazard ratio AHR : Adjusted hazard ratio CI : Confidence interval Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4214041","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":288817385,"identity":"c3909af5-be47-48ee-ba65-9cbb26db6a1f","order_by":0,"name":"Amanuel Zeleke","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYDACZh6GA1BW4wMgycNHghbGZgOQFjbC1vDAGIxtEiCKoBbzdt6Dh27m2OUZHG9sq/yaYyfDxsD88NENPFpkDvMlHM7dllxscOZg223ZbclAh7EZG+fg0SLBzGMA1MKcuOFGYtttyW3MQC08bNJEaKlP3HD/YVux5LZ6orUcBtrC2Mb4cdthYrSA/XI8ceaZxGZpxm3HediYCfmF/+zhz7nbqhP7jh8++PHntmp7fvbmh4/xaUEBzOA4YiZWOQgw/iBF9SgYBaNgFIwYAABjOEhziK1XVgAAAABJRU5ErkJggg==","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":true,"prefix":"","firstName":"Amanuel","middleName":"","lastName":"Zeleke","suffix":""},{"id":288817386,"identity":"207f7de4-bbd8-4c66-ba9a-75e9ae049436","order_by":1,"name":"Alazar Sitotaw","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Alazar","middleName":"","lastName":"Sitotaw","suffix":""},{"id":288817388,"identity":"aaba8356-06d5-4f25-ad02-1b27fd3f9dad","order_by":2,"name":"Balew Arega","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Balew","middleName":"","lastName":"Arega","suffix":""},{"id":288817390,"identity":"766e7bb3-8b63-4733-8e74-50ef18320637","order_by":3,"name":"Elias Tewabe","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Elias","middleName":"","lastName":"Tewabe","suffix":""},{"id":288817393,"identity":"a3b71fff-163f-42e6-9a3e-ea3808e1465c","order_by":4,"name":"Gashaw Solela","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Gashaw","middleName":"","lastName":"Solela","suffix":""},{"id":288817395,"identity":"837fa6b6-bfce-46ee-a9c0-3802dc9853c8","order_by":5,"name":"Haileyesus Teshome","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Haileyesus","middleName":"","lastName":"Teshome","suffix":""},{"id":288817396,"identity":"9a3a5b81-c27f-4086-b9c1-bb7029e32cc6","order_by":6,"name":"Hanna Hailemichael","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Hanna","middleName":"","lastName":"Hailemichael","suffix":""},{"id":288817398,"identity":"8d0f10fa-d870-4cbc-937b-1ef2ae9a4233","order_by":7,"name":"Seble Legese","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Seble","middleName":"","lastName":"Legese","suffix":""},{"id":288817399,"identity":"7cf87297-1d42-4455-b528-052b2490ea6c","order_by":8,"name":"Sebrina Ahmed","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Sebrina","middleName":"","lastName":"Ahmed","suffix":""},{"id":288817400,"identity":"750986fb-83ce-4127-bbe5-c905fc103fbd","order_by":9,"name":"Selam Bogale","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Selam","middleName":"","lastName":"Bogale","suffix":""},{"id":288817401,"identity":"1c3de905-4677-414b-b4f4-f6b2bec41858","order_by":10,"name":"Simret Hailemichael","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Simret","middleName":"","lastName":"Hailemichael","suffix":""},{"id":288817402,"identity":"5fa4d40d-769c-4fdd-8d21-622ca48a335d","order_by":11,"name":"Anteneh Mitiku","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Anteneh","middleName":"","lastName":"Mitiku","suffix":""},{"id":288817403,"identity":"ac2899ee-bec6-48ce-9ba4-7e9a00329524","order_by":12,"name":"Getabalew Endazenaw","email":"","orcid":"","institution":"Yekatit 12 Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Getabalew","middleName":"","lastName":"Endazenaw","suffix":""},{"id":288817404,"identity":"f7dedeee-5d43-4fdf-9dcb-94bc2a3334b8","order_by":13,"name":"Eyuel Tsegaye","email":"","orcid":"","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Eyuel","middleName":"","lastName":"Tsegaye","suffix":""},{"id":288817405,"identity":"b5267707-b61d-49cb-82ca-5664d213b4df","order_by":14,"name":"Anteneh Eshetu","email":"","orcid":"","institution":"Tikur Anbessa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Anteneh","middleName":"","lastName":"Eshetu","suffix":""}],"badges":[],"createdAt":"2024-04-03 16:35:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4214041/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4214041/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54521098,"identity":"bc6e6590-c741-445b-823d-35cf9bb78b92","added_by":"auto","created_at":"2024-04-11 18:08:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24733,"visible":true,"origin":"","legend":"\u003cp\u003eBacterial isolates from septic shock patients at Y12HMC from January to September 2023\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4214041/v1/1565408055ebfeccfe1b5d6d.png"},{"id":54521097,"identity":"37a3e334-8e31-4c84-b14e-421b4618f218","added_by":"auto","created_at":"2024-04-11 18:08:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16953,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier curve of septic shock mortality at Y12HMC from January to September 2023\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4214041/v1/f90bab1283dbd26752e01c62.png"},{"id":63351988,"identity":"0385b6b6-1692-4614-a004-733eb479c048","added_by":"auto","created_at":"2024-08-27 08:35:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":958849,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4214041/v1/c5eed644-e3a3-4e2c-acfc-8744b150f0d0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictors of Septic Shock Mortality at a Tertiary Hospital in Ethiopia: A Prospective Observational Study","fulltext":[{"header":"Background","content":"\u003cp\u003eSeptic shock is a major health care problem, impacting millions of people around the world each year and killing between one in three and one in six of those it affects\u0026nbsp;[1, 2]. The\u0026nbsp;incidence\u0026nbsp;of\u0026nbsp;septic\u0026nbsp;shock\u0026nbsp;is\u0026nbsp;increasing\u0026nbsp;on\u0026nbsp;a\u0026nbsp;global\u0026nbsp;scale.\u0026nbsp;It has become one of the frequent reasons for intensive care unit (ICU) admissions and the leading cause of death in critically ill patient\u0026nbsp;[2, 3].\u0026nbsp;Despite advances in recognition and\u0026nbsp;treatment\u0026nbsp;of\u0026nbsp;septic\u0026nbsp;shock,\u0026nbsp;its in-hospital\u0026nbsp;mortality\u0026nbsp;remains\u0026nbsp;alarmingly\u0026nbsp;high,\u0026nbsp;with\u0026nbsp;rates\u0026nbsp;ranging\u0026nbsp;from\u0026nbsp;30% to 50% according to recent studies\u0026nbsp;[4, 5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Ethiopia, prior studies showed a high level of septic shock mortality rate with 53.8%\u003csup\u003e\u0026nbsp;\u003c/sup\u003eat Tikur Anbessa Specialized Hospital\u0026nbsp;[2]\u0026nbsp;and 42% at the University of Gondar Hospital\u0026nbsp;[5]. Both of these studies were retrospective in nature and had a small sample size.\u0026nbsp;Hence, the results of these studies can be affected by incompleteness of data and lack of generalization to the general population. The in-hospital mortality rate of septic shock patients is potentially affected by the presence of comorbidities, early guideline-based treatment, local antimicrobial resistance, and the availability of human expert\u0026nbsp;[1, 5]. This indicates that local factors determine the magnitude of septic shock morality and identifying\u0026nbsp;specific factors associated\u0026nbsp;with\u0026nbsp;poor\u0026nbsp;outcomes\u0026nbsp;enables clinicians to practice evidence-based medicine and to improve patients\u0026apos; outcomes.\u003c/p\u003e\n\u003cp\u003eIn this study, we investigated in-hospital mortality of septic shock and its predictors in the context of Ethiopia. The results would help the clinical and administrative personnel in the hospital care of septic shock patients with a consequent mortality reduction. In addition, it would be used as an evidence to develop hospital-based protocols and national guidelines to address the burden of the problem in the country.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy setting, design, and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA hospital-based prospective observational study was conducted from January to September 2023 among septic shock patients admitted to Yekatit 12 Hospital Medical College, a teaching hospital in Addis Ababa, Ethiopia. It is one of the largest hospitals in the country, with over 500 beds, treating approximately 310,000 patients each year, and having 21 departments and units. The hospital has a ten-bed adult ICU that serves about 350 to 400 adult patients per year.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population and variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included septic shock patients (age \u0026ge; 15 years old) admitted to the adult ICU. We used Sepsis-3 definition to screen sepsis patients using systemic inflammatory response syndrome (SIRS) and/or sequential organ failure assessment (SOFA) criteria. Those sepsis patients who required vasopressor to keep systolic blood pressure (SBP) \u0026ge;100 mmHg despite adequate fluid resuscitation were diagnosed to have septic shock.\u0026nbsp;Patients with other types of shock and any form of cardiac problem(s) were excluded. We followed patients from admission to discharge to determine the outcome (mortality). The number of septic shock deaths divided by the total number of septic shock patients yielded the mortality rate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedure, tools, and data quality control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe obtained an ethical approval from the Y12HMC (protocol number: 314/23) and informed consent from the patients. Trained internal medicine residents collected both the primary and secondary data. \u0026nbsp;Sociodemographic and behavioral characteristics were collected by interviews with the patients and/or their caregivers. The clinical parameters, primary focus of infection, comorbidities, complications, laboratory and management-related factors were extracted from the electronic medical records of the patients. The data collection process was supervised and monitored by the principal investigator. We rechecked the collected data daily for completeness and consistency.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS version 25 was used for data entry and analysis. The entered data were cleaned and checked for consistency. \u0026nbsp;Descriptive statistics were used to calculate frequency, percentage, mean, and ranges. \u0026nbsp; Bivariable and multivariable analyses using the Cox regression model were used to identify predictors of septic shock mortality. A hazard ratio with a 95% confidence interval was used to determine the strength of association between the outcome variable and the independent variables. \u003cem\u003eP-\u003c/em\u003evalues \u0026lt; 0.05 were considered as statistically significant. The incidence of mortality during the hospital stays was presented using the Kaplan-Meier curve.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne hundred forty-four\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eseptic shock patients were found to be eligible and included in the study with a response rate of 100%. The mean age was 46 \u0026plusmn; 19 years with a range of 15 to 95 years.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe majority of patients (55.6%) were males. Approximately, one-third (30%) of the patients had recent admission in the past 3 months. However, it was difficult to specify the type of drug(s) that were taken by patients before the current admission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eSociodemographic characteristics of septic shock patients at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAround 93% to 98% of patients had abnormal body temperature, respiratory rate, heart rate, white cell counts and peripheral oxygen saturation which were consistent with the SIRS and/or SOFA criteria. Altered mental status, elevated creatinine and mild to severe thrombocytopenia were also found in 50% to 60% of patients. An abnormal total bilirubin was only seen in 14.6% of the cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eClinical and laboratory parameters of septic shock at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNearly, two-third of the patients (68%) had one or more comorbidities. The most common comorbidity was human immunodeficiency virus (18.8%) followed by diabetes mellitus (17.4%) and chronic lung disease (14.6%). After admission, five patients had developed venous thromboembolism (VTE) and three cases of tuberculosis-associated sepsis were diagnosed with sputum gene xpert and/or urine lipoarabinomannan (LAM).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eComorbidities of septic shock patients at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFocus of infection and sepsis related organ dysfunction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePulmonary infection was identified in about 70% of the patients followed by gastrointestinal (34.7%) and central nervous system (10.4%) infections. Twenty cases (13.9%) had wound, genitourinary and skin/soft tissue infections. None of the participants had catheter-associated blood stream infection, IV site or other focus of infection. Most of the patients (90%) had developed one or more sepsis related organ dysfunctions. The commonest identified complications were electrolyte disorders (63.9%) acute kidney injury (51.4%) and acute respiratory failure (50.7%). One-third of the patients were complicated with mild to severe thrombocytopenia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003eInfection focuses and complications of septic shock at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicrobiologic evidences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBlood culture was done for a total of 83 (57.6%) patients and it was done twice for less than one-third of the patients. A sample for culture was taken before antimicrobial administration in 78 (94%) patients. Only seven blood culture results were found to be positive of which four revealed gram-negative isolates and three revealed gram-positive isolates. The available antimicrobials for the sensitivity test were amoxicillin-clavulanic acid, ceftriaxone, ceftazidime, cefepime, ciprofloxacin, clindamycin, cotrimoxazole, erythromycin, gentamycin, meropenem and vancomycin. Antimicrobials were revised based on the culture results. Gene xpert/urine LAM were done for 14 patients of which only three were positive.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u0026nbsp;\u003c/strong\u003eBlood culture results of septic shock patients at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1\u003c/strong\u003e: Bacterial isolates from septic shock patients at Y12HMC from January to September 2023\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment modalities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were given crystalloid fluid, antimicrobials and vasopressors. For almost all cases (95%), antimicrobials were initiated within the first 3 hours of diagnosis. The three commonly utilized antimicrobials were vancomycin (97.9%), ceftazidime (51.4%) and cefepime (30%). The first widely used vasopressor was adrenaline (70%) followed by noradrenaline (27.8%). Eighteen (12.5%) and ninety-three (64.6%) patients had required second vasopressor and hydrocortisone for refractory septic shock, respectively. None of them had taken dobutamine. All treatment modalities were administered via peripheral intravenous access.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003eVasopressors and antimicrobials utilization for septic shock at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIn-hospital mortality rate of septic shock\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and length of hospital stay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall in-hospital mortality rate of septic shock patient was 66.7%. The median length of hospital stay was 6 days (IQR: 2-11 days). The minimum and maximum length of hospital stay was ranged from 1 to 49 days. Many deaths occurred in the first 10 days of admission. Half of the total cases died within the first three weeks of admission.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2:\u0026nbsp;\u003c/strong\u003eKaplan-Meier curve of septic shock mortality at\u0026nbsp;Y12HMC from January to September 2023\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors of septic shock in-hospital mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBivariable Cox regression analysis showed that low GCS (CHR: 1.84, 95% CI, 1.19-2.86, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.01) and low SpO2 (CHR: 5.24, 95% CI: 4.73-37.73, \u003cem\u003eP\u003c/em\u003e = 0.05) at the time of diagnosis; acute respiratory failure (CHR: 1.52, 95% CI: 1.22-2.32, \u003cem\u003eP\u003c/em\u003e = 0.04) were significantly associated with an increased risk of septic shock in-hospital mortality. The multivariable Cox regression analysis revealed that low GCS (AHR: 2.23, 95% CI: 1.35-3.69, \u003cem\u003eP\u003c/em\u003e = 0.01) and low SpO2 (AHR: 8.74, 95% CI: 1.18-14.84, \u003cem\u003eP\u003c/em\u003e = 0.03) at the time of diagnosis were independently associated with a greater risk of septic shock in-hospital mortality. The relative risk of death in patients who had low GCS and SpO2 was likely 2 and 8 times higher compared to those who had normal GCS and SpO2 at the time of diagnosis, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7:\u0026nbsp;\u003c/strong\u003eBivariable and multivariable analysis of septic shock patients at Y12HMC from January to September 2023\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main objective of this study was to provide representative data on the predictors of septic shock outcomes in Ethiopia. The study found that the overall in-hospital mortality of septic shock was 66.7%. The multivariable analysis using the Cox regression analysis demonstrated that low GCS and low peripheral oxygen saturation at the time of diagnosis were independent determinants of septic shock in-hospital mortality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, the overall in-hospital mortality of septic shock is very high compared to the recent literatures published in Europe [6, 7]. Our finding is also higher than the reports in other tertiary hospitals in Ethiopia such as Tikur Anbessa Specialized Hospital (58.3%)\u0026nbsp;[2]\u0026nbsp;and University of Gondar Hospital (42%) [5]. This can be partly explained by the absence of infectious disease, and pulmonary and critical care Sub-specialists. Besides, the absence of well-customized hospital-based protocols for early identification and management of septic shock may contribute to higher mortality. In addition to limited knowledge and resources, septic shock mortality in Sub-Saharan Africa is believed to be disproportionately high due to widespread malnutrition, sub-optimally managed comorbidities and higher rates of infectious diseases including HIV and TB [4, 5, 8, 9]. Around 68% of patients had one or more comorbidities and HIV was found in 18.8% of the cases in our study. This is consistent with many studies which may contribute to the high mortality [2, 4-6, 8, 10].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFactors affecting in-hospital mortality in septic shock patients remain uncertain [5, 10, 11]. Several studies [6, 7, 12-17] have shown that the presence of one or more comorbidities, focuses of infection, organ failures and initial severity of septic shock (higher SIRS/SOFA scores) negatively affect septic shock outcome.\u0026nbsp;In our study, altered mental status and low levels of peripheral oxygen saturation at the time of diagnosis were significantly associated with a greater risk of septic shock in-hospital mortality. Altered mentation for several reasons on its own is associated with worse patient outcome and doubles the poor prognosis in these patients. Sepsis-associated encephalopathy is related to increased short-term mortality in patients with septic shock [8, 16, 18-19]. Likewise, low oxygenation in patients with septic shock was also associated with a higher organ dysfunctions and death\u0026nbsp;[3].\u003c/p\u003e\n\u003cp\u003eThe respiratory tract was the leading primary source of infection in 70% of cases followed by the gastrointestinal tract (34.7%). This finding is consistent with most studies conducted in both developed and developing nation\u0026nbsp;[2, 4, 17]. In our study, 10.4% of the cases had a clinical diagnosis of meningitis leading to septic shock. Several case reports and case series provide supports that bacterial meningitis continues to be a relevant cause of septic shock\u0026nbsp;[1, 18-19]. In this study, neither respiratory tract nor CNS focuses were associated with septic shock mortality. Unlike other studies, none of the participants developed catheter-associated blood stream and IV site infections\u0026nbsp;[10]. The reasons to the later findings are probably related to the difference in the study population.\u003c/p\u003e\n\u003cp\u003eElectrolyte disorders (these included low or high levels of serum sodium, potassium, calcium and/or magnesium) were the most common complications in this study. Some of the explanations are pulmonary and CNS infections can cause hyponatremia due to the syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and gastrointestinal sepsis can result in the loss of one or more electrolytes. We noted that respiratory and gastrointestinal tracts were the common focuses of sepsis in our study, which can explain the presence of one or more electrolyte disorders.\u003c/p\u003e\n\u003cp\u003eCompared to studies conducted in the USA and Europe where septic shock tends to occur more in the elderly\u0026nbsp;[3, 6, 12], this study found that all age groups were affected proportionally. This difference can be due to a longer life expectancy in the developed nations where elderly individuals were affected more likely. \u0026nbsp;On the other hand, a dramatically increased prevalence of non-communicable diseases in addition to the high burden of communicable diseases affecting the young and middle-aged population in this setting may explain our findings. In line with several literatures\u0026nbsp;[2, 3, 5-6], more than half of the cases had one or more comorbidities and 90% of the total patients developed one or more organ dysfunction(s) in this study.\u003c/p\u003e\n\u003cp\u003eIn our study, 64.6% of patients received corticosteroids and it indirectly indicates the burden of refractory septic shock not responding to fluid and vasopressor therapy alone. Literatures showed that steroid use has not any mortality benefit but it has shown to provide better hemodynamic response in patients with septic shock\u0026nbsp;[5]. Thus, the role of steroids in septic shock is limited only to refractory cases of fluid and vasopressor therapy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSimilar to studies done by Shibiru et al\u0026nbsp;[5]; this study showed no statistical difference in mortality regarding the type of vasopressor and steroid utilized. However, it is difficult to conclude without controlling the effect of other treatment-related factors. Some studies have shown the negative effect of delayed initiation of antimicrobial in determining the outcome of septic shock\u0026nbsp;[9, 20]. This effect was absent in our study probably because that antimicrobials were initiated within the first 3 hours of diagnosis nearly for all cases (95%) in line with the 3-hour sepsis bundle. Compared to other hospitals\u0026nbsp;[1, 4, 17], the culture yield was very low (around 10%) in this study.\u0026nbsp;As our study participants were septic shock patients, the treatment should be guided by the local culture and sensitivity results.\u003c/p\u003e\n\u003cp\u003eWe evaluated the outcome of septic shock patients by prospective observational study design using comprehensive and multidimensional parameters. It is also the first study carried out in our hospital that identified predictors of poor septic shock outcomes. However, the study was a single-centered with a relatively small sample size.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSeptic shock has a higher mortality at a teaching hospital in Ethiopia, where nearly two-third of the patients died. Septic shock patients had more comorbidities, multiple sepsis- related organ dysfunctions and multiple focuses of infection causing death. Low levels of the Glasgow coma scale and peripheral oxygen saturation at the time of diagnosis were the independent predictors associated with a higher risk of in-hospital mortality in our study. Strategies (e.g. a facilitated referral system) shall be paved to let patients with septic shock visit health facilities early.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePrompt recognition and early goal-directed therapy is essential for a better outcome.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe microbiology unit has to use advanced technologies, guided by national and international recommendations for sample collection and screening to increase the yield of the culture. This allows the treating Physicians to revise the antimicrobials based on the culture results.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCONS:\u003c/strong\u003e Coagulase negative staphylococcus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDHS:\u0026nbsp;\u003c/strong\u003eDemographic and health survey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEGDT:\u003c/strong\u003e Early goal directed therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGCS:\u0026nbsp;\u003c/strong\u003eGlasgow coma scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003emmHg:\u003c/strong\u003e Millimeter mercury\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpO2:\u003c/strong\u003e Peripheral oxygen saturation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSLE:\u0026nbsp;\u003c/strong\u003eSystemic lupus erythematous\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVTE:\u003c/strong\u003e Venous thromboembolism\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe\u0026nbsp;obtained\u0026nbsp;ethical approval\u0026nbsp;from the\u0026nbsp;Yekatit 12 Hospital Medical College\u0026nbsp;Ethical\u0026nbsp;Review\u0026nbsp;Committee.\u0026nbsp;Written informed consent was taken from the patients and/or caregivers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no any competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research has no received funding support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAZ, AM, GE, and ETS contributed to the study design and data collection tool.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAS and\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eHT were involved in data collection. HH and SL entered the data. AZ, ETA, SA, and SH analyzed and interpreted the data. AZ, BA, GS, SBG, and AE involved in the final writing of the manuscript. All authors read and approved the final paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo special acknowledgement\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOctora M, Mertaniasih NM, Semedi BP, Koendhori EB. Predictive Score Model of Clinical Outcomes Sepsis in Intensive Care Unit Tertier Referral Hospital of Eastern Indonesia. Open Access Maced J Med Sci. 2021;9 Apache Ii:1710\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eTeklemichael H. Assessment of the Incidence and Treatment Outcome of Septic Shock Among Patients Admitted Adult To Intensive Care Unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. 2017.\u003c/li\u003e\n\u003cli\u003eCarrara M, Baselli G, Ferrario M. Mortality Prediction Model of Septic Shock Patients Based on Routinely Recorded Data. Comput Math Methods Med. 2015;2015.\u003c/li\u003e\n\u003cli\u003eMulatu HA, Bayisa T, Worku Y, Lazarus JJ, Woldeyes E, Bacha D, et al. Prevalence and outcome of sepsis and septic shock in intensive care units in Addis Ababa, Ethiopia: A prospective observational study. African J Emerg Med. 2021;11:188\u0026ndash;95.\u003c/li\u003e\n\u003cli\u003eShibru H, Muhie OA, Yesuf T, Shenkutie Greffie E, Mitiku T, Admasu Z, et al. Outcome of Septic Shock and Associated Factors at the University of Gondar Hospital: A Retrospective Cohort Study. J Intensive Crit Care. 2020;6:1\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eDaviaud F, Grimaldi D, Dechartres A, Charpentier J, Geri G, Marin N, et al. Timing and causes of death in septic shock. Ann Intensive Care. 2015;5.\u003c/li\u003e\n\u003cli\u003eSong JE, Kim MH, Jeong WY, Jung IY, Oh DH, Kim YC, et al. Mortality risk factors for patients with septic shock after implementation of the surviving sepsis campaign bundles. Infect Chemother. 2016;48:199\u0026ndash;208.\u003c/li\u003e\n\u003cli\u003eHopkinson DA, Mvukiyehe JP, Jayaraman SP, Syed AA, Dworkin MS, Mucyo W, et al. Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality. PLoS One. 2021;16 5 May 2021:1\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003ePuchalski Ritchie LM, Beza L, Debebe F, Wubetie A, Gamble K, Lebovic G, et al. Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis. Implement Sci. 2022;17:1\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eLeedahl DD, Personett HA, Gajic O, Kashyap R, Schramm GE. Predictors of mortality among bacteremic patients with septic shock receiving appropriate antimicrobial therapy. BMC Anesthesiol. 2014;14.\u003c/li\u003e\n\u003cli\u003eKaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. Jama. 2014;311:1308\u0026ndash;16.\u003c/li\u003e\n\u003cli\u003eChen S, Gao Z, Hu L, Zuo Y, Fu Y, Wei M, et al. Association of Septic Shock with Mortality in Hospitalized COVID-19 Patients in Wuhan, China. Adv Virol. 2022;2022.\u003c/li\u003e\n\u003cli\u003eLissalde-Lavigne G, Combescure C, Muller L, Bengler C, Raillard A, Lefrant JY, et al. Simple coagulation tests improve survival prediction in patients with septic shock. J Thromb Haemost. 2008;6:645\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003eHagiwara A, Tanaka N, Inaba Y, Gando S, Shiraishi A, Saitoh D, et al. Predictors of severe sepsis-related in-hospital mortality based on a multicenter cohort study. Medicine (Baltimore). 2021;100:e24844.\u003c/li\u003e\n\u003cli\u003eVucelić V, Klobučar I, Đuras-Cuculić B, Grginić AG, Prohaska-Potočnik C, Jajić I, et al. Sepsis and septic shock \u0026ndash; an observational study of the incidence, management, and mortality predictors in a medical intensive care unit. Croat Med J. 2021;61:429\u0026ndash;39.\u003c/li\u003e\n\u003cli\u003eYang Y, Liang S, Geng J, Wang Q, Wang P, Cao Y, et al. Development of a nomogram to predict 30-day mortality of patients with sepsis-associated encephalopathy: A retrospective cohort study. J Intensive Care. 2020;8:1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eRamzi J, Mohamed Z, Yosr B, Karima K, Raihane B, Lamia A, et al. Predictive factors of septic shock and mortality in neutropenic patients. Hematology. 2007;12:543\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eDienstmann G, Avi KT, Leite LAC, Alano JS, Souza MLR de, Mulazani M da S, et al. First case report of fulminant septic shock from meningococcemia associated with Cryptococcus neoformans coinfection in an immunocompetent patient. Med Mycol Case Rep. 2019;26 September:44\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003ePota V, Passavanti MB, Coppolino F, Di Zazzo F, De Nardis L, Esposito R, et al. Septic shock due to Escherichia coli meningoencephalitis treated with immunoglobulin-M-enriched immunoglobulin preparation as adjuvant therapy: a case report. J Med Case Rep. 2021;15:1\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eDugar S, Choudhary C, Duggal A. Sepsis and septic shock: Guideline-based management. Cleve Clin J Med. 2020 Jan;87(1):53-64. doi: 10.3949/ccjm.87a.18143. Epub 2020 Jan 2. PMID: 31990655\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eSociodemographic characteristics of septic shock patients at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivors (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-survivors (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e80 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e29 (20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e51 (35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e64 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e19 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e45 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Age\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;15-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e22 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e9 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e13 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e22 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e11(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e11 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e28 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e9 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e19 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;45-54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e28 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e7 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e21 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;55-64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e18 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e7 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e11 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026ge;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e26 (18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e21 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; Residence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;A.A Bole sub-city\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e31\u0026nbsp;(21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e26 (18.1)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;A.A Arada sub-city\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e20\u0026nbsp;(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e8 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e12 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;A.A Yeka sub-city\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e20\u0026nbsp;(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e7 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e13 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;A.A Lemi Kura sub-city\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e15\u0026nbsp;(10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e6 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e9 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Others\u003cstrong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" valign=\"top\"\u003e\n \u003cp\u003e58\u0026nbsp;(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.587628865979383%\" valign=\"top\"\u003e\n \u003cp\u003e22 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.742268041237114%\" valign=\"top\"\u003e\n \u003cp\u003e46 (31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003cem\u003eEthiopian demographic and health survey (EDHS) age category, A.A: Addis Ababa\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003cem\u003eAmhara region, Oromia region, South nations, nationalities and peoples region, other sub-cities of Addis Ababa (Kirkos, Gulele, Addis Ketema, Lideta, Lafto, Kaliti, Nifas Silk)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eClinical and laboratory parameters of septic shock at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"588\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall frequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivors (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-survivors (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFocus of infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Respiratory tract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e101 (70.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e27 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e74 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Gastrointestinal tract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e50 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e18 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e32 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Central nervous system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e15 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e14 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Wound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e13 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e3 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e10 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Genitourinary tract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e6 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e3 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e3 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Skin/soft tissue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;One focus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e104 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e43 (29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e61 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Multiple focuses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e40 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e35 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrgan dysfunction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Electrolyte disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e92 (63.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e25 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e67 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Acute kidney injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e74 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e25 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e49 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Respiratory failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e73 (50.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e11 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e62 (43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Thrombocytopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e42 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e14 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e28 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Acute brain failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e27 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e25 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Acute liver injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e17 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e12 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Metabolic disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e17 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e4 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e13 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Arrhythmia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e16 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e14 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No organ failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e14 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e6 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e8 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;One organ failure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e35 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e15 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e20 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Multi-organ failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e95 (66.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.346938775510203%\" valign=\"top\"\u003e\n \u003cp\u003e27 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e68 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eComorbidities of septic shock patients at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictors of in-hospital mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI for CHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI for AHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eGCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003e1.19-2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1.35-3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eSpO2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003e4.71-7.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e8.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1.18-14.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eRespiratory failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003e1.22-2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.88-2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCHR\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: Crude hazard ratio \u0026nbsp; \u003cstrong\u003eAHR\u003c/strong\u003e: Adjusted hazard ratio \u0026nbsp; \u003cstrong\u003eCI\u003c/strong\u003e: Confidence interval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003eInfection focuses and complications of septic shock at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"618\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSIRS/SOFA criteria at the time of diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-survivors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Systolic blood pressure \u0026le; 100 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e144 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e48 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e96 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Respiratory rate \u0026gt; 20 breaths per minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e141 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e45 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e96 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Heart rate \u0026gt; 90 beats per minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e140 (97.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e46 (31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e94 (65.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Temperature \u0026lt;36 \u0026ordm;C or \u0026gt;38 \u0026ordm;C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e135 (93.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e45 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e90 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;White cell count \u0026lt; 4*10\u003csup\u003e3\u003c/sup\u003e or \u0026gt; 12*10\u003csup\u003e3 \u0026nbsp;\u003c/sup\u003ecells/ul\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e135 (93.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e46 (31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e89 (61.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Peripheral oxygen saturation \u0026lt; 90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e134 (93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e39 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e95 (65.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Glasgow coma scale \u0026lt; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e82 (56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e15 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e67 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Creatinine \u0026ge; 1.2 mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e74 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e27 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e47 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Platelets \u0026le; 150*10\u003csup\u003e3\u0026nbsp;\u003c/sup\u003ecells/ul\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e69 (47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e22 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e47 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.42718446601942%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Total bilirubin \u0026nbsp;\u0026ge; 1.2 mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.533980582524272%\" valign=\"top\"\u003e\n \u003cp\u003e21 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\" valign=\"top\"\u003e\n \u003cp\u003e10 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.446601941747574%\" valign=\"top\"\u003e\n \u003cp\u003e11 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003eFrequency of septic shock patients who had the specific SIRS or SOFA criteria at the time of diagnosis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u0026nbsp;\u003c/strong\u003eBlood culture results of septic shock patients at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"561\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvivors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-survivors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eHuman immunodeficiency virus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e27 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e6 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e21 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e25 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e7 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e18 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eChronic lung disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e21 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e7 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e14 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e19 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e14 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e16 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e9 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e7 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e9 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e4 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eChronic liver disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e8 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e7 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eChronic kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e7 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e14 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e3 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e11 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eNo comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e46 (31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e20 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e26 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eOne comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e67 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e17 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e50 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"top\"\u003e\n \u003cp\u003eMultiple comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.642857142857142%\" valign=\"top\"\u003e\n \u003cp\u003e31 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.071428571428573%\" valign=\"top\"\u003e\n \u003cp\u003e11 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.785714285714285%\" valign=\"top\"\u003e\n \u003cp\u003e20 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003cem\u003eAlcohol use disorder, Alzheimer\u0026rsquo;s disease, anemia, pancreatitis, benign prostatic hyperplasia [BPH], malnutrition, Parkinson\u0026rsquo;s disease, rheumatoid arthritis, systemic lupus erythematosus [SLE] (each accounted one case), VTE (5 cases)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003eVasopressors and antimicrobials utilization for septic shock at Y12HMC from January to September 2023 (N=144)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"390\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.69230769230769%\" valign=\"top\" style=\"width: 47.3712%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood culture results\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.87179487179487%\" valign=\"top\" style=\"width: 34.8777%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.435897435897434%\" valign=\"top\" style=\"width: 12.9099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.570332480818415%\" valign=\"top\" style=\"width: 47.3712%;\"\u003e\n \u003cp\u003eCulture done\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.78260869565217%\" valign=\"top\" style=\"width: 34.8777%;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\" style=\"width: 17.4388%;\"\u003e\n \u003cp\u003e57.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.570332480818415%\" valign=\"top\" style=\"width: 47.3712%;\"\u003e\n \u003cp\u003eOne sample\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.78260869565217%\" valign=\"top\" style=\"width: 34.8777%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\" style=\"width: 17.4388%;\"\u003e\n \u003cp\u003e72.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.570332480818415%\" valign=\"top\" style=\"width: 47.3712%;\"\u003e\n \u003cp\u003eTwo sample\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.78260869565217%\" valign=\"top\" style=\"width: 34.8777%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\" style=\"width: 17.4388%;\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.570332480818415%\" valign=\"top\" style=\"width: 47.3712%;\"\u003e\n \u003cp\u003eCulture positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.78260869565217%\" valign=\"top\" style=\"width: 34.8777%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\" style=\"width: 17.4388%;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntimicrobials utilized\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Vancomycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e97.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ceftazidime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cefepime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e29.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Meropenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Metronidazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ceftriaxone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ciprofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ampicillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntimicrobial initiation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026lt;1 hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;1-3 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e72.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;3-6 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003csup\u003est\u003c/sup\u003e vasopressor \u0026nbsp;utilized\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Adrenaline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e70.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Noradrenaline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Dopamine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003csup\u003end\u003c/sup\u003e vasopressor \u0026nbsp;utilized\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Dopamine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.09836065573771%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Adrenaline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.229508196721312%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.672131147540984%\" valign=\"top\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7:\u0026nbsp;\u003c/strong\u003eBivariable and multivariable analysis of septic shock patients at Y12HMC from January to September 2023\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictors of in-hospital mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI for CHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI for AHR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eGCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003e1.19-2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1.35-3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eSpO2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003e4.71-7.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e8.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1.18-14.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.041666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eRespiratory failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003e1.22-2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.88-2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCHR\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: Crude hazard ratio \u0026nbsp; \u003cstrong\u003eAHR\u003c/strong\u003e: Adjusted hazard ratio \u0026nbsp; \u003cstrong\u003eCI\u003c/strong\u003e: Confidence interval\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Septic shock, Predictors, In-hospital mortality, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4214041/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4214041/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Septic shock causes significant mortality, ranging from 30% to 50%, with a slight difference in developing and developed countries. There is insufficient evidence in Ethiopia regarding septic shock mortality. Therefore, we aimed to determine the in-hospital mortality rate and its predictors among septic shock patients admitted to a tertiary hospital in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A hospital-based prospective observational study was conducted among septic shock patients admitted to Yekatit 12 Hospital Medical College (Y12HMC) from January to September 2023. All patients with septic shock who fulfilled the inclusion criteria were included and followed until discharge or death. We collected sociodemographic characteristics, clinical and laboratory parameters, microbiologic findings, and treatment-related data from eligible patients using a standardized data extraction format. Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) version 25. The multivariable analysis using the Cox regression model was used to determine the predictors of in-hospital mortality, with \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 representing statistical significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 144 septic shock patients were included in the study. The mean age was 46 ± 19 years, with a range of 15 to 95 years. The overall in-hospital mortality of septic shock patients was 66.7%. The multivariable Cox regression analysis revealed that low Glasgow coma scale (GCS) [adjusted hazard ratio: 2.23, 95% CI: 1.35-3.69, \u003cem\u003eP\u003c/em\u003e = 0.01] and low peripheral oxygen saturation (SpO2) [adjusted hazard ratio: 8.74, 95% CI: 1.18-14.84, \u003cem\u003eP\u003c/em\u003e = 0.03] at diagnosis were independently associated with a higher risk of in-hospital mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Septic shock mortality was found significantly higher in our study. Septic shock patients with low GCS and SpO2 at the time of diagnosis require a vigilant care. Early identification of high-risk patients, applying appropriate and compressive management could reduce the mortality.\u003c/p\u003e","manuscriptTitle":"Predictors of Septic Shock Mortality at a Tertiary Hospital in Ethiopia: A Prospective Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-11 18:08:38","doi":"10.21203/rs.3.rs-4214041/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ec4d5310-7a35-47be-91cc-6f5c19b8669d","owner":[],"postedDate":"April 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-27T08:27:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-11 18:08:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4214041","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4214041","identity":"rs-4214041","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}