Study of Risk Factors and Prognosis in Patients with Septic Shock admitted to Damascus National Hospital, Cross-Sectional Study

Study of Risk Factors and Prognosis in Patients with Septic Shock admitted to Damascus National Hospital, Cross-Sectional 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 Study of Risk Factors and Prognosis in Patients with Septic Shock admitted to Damascus National Hospital, Cross-Sectional Study Sami Yaser Dib, Nizar Al-Daher, Haidar Yousef This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6582501/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, the most severe complication of sepsis, is a life-threatening condition characterized by profound circulatory, cellular, and metabolic dysfunction. It carries a high mortality rate worldwide, particularly in resource-limited settings where delayed diagnosis, inadequate antimicrobial stewardship, and limited critical care infrastructure exacerbate outcomes. In Syria, the ongoing socioeconomic crisis has severely impacted healthcare delivery, with rising infectious disease burdens, antibiotic resistance, and suboptimal management of sepsis. Purpose This study aims to identify the key risk factors, infection sources, and mortality predictors of septic shock among patients admitted to Damascus National Hospital, providing critical insights into ist epidemiology and outcomes in a crisis-affected population. Methods The study was conducted on 99 patients diagnosed with septic shock and admitted to Damascus National Hospital between April 1, 2023, and April 1, 2024. A comprehensive medical history was obtained from each patient to identify potential risk factors for septic shock. A multi-system clinical examination was performed, Laboratory investigations were requested, including complete blood count (CBC), blood glucose, creatinine, liver enzymes, urinalysis, blood cultures and cultures from suspected infection sites along with medical imaging to identify the source of septic shock or related complications. Patients were monitored for one month to assess prognosis. Statistical analysis was performed using SPSS-26 with a p-value > 0.05 considered statistically significant. Results Septic shock was more common in females than males, with increased risk in advanced age (> 50 years). The most frequently observed risk factors were advanced age (> 50), diabetes mellitus, and poor patient compliance with treatment in our society. The risk of septic shock significantly increased with a higher number of risk factors per patient. Pulmonary infections were the most common source of infection leading to septic shock. Mortality occurred in the majority of patients (93.93%), indicating a poor prognosis. Conclusions Our study demonstrates that septic shock is a serious complication in our society, primarily associated with post-infectious mortality. Regardless of risk factors, the survival rate does not exceed 3%, attributed to antibiotic misuse, rising antibiotic resistance, and inadequate medical services and healthcare** due to the country’s deteriorating economic conditions. septic shock risk factor prognosis mortality recover Introduction Sepsis represents a clinical continuum of pathophysiological states, progressing from systemic inflammatory response syndrome (SIRS) to multiorgan dysfunction syndrome (MODS) and, ultimately, death. Initial inflammatory manifestations include fever (temperature > 38°C) or hypothermia ( 90 beats/min), tachypnea (respiratory rate > 20 breaths/min), and leukocytosis (white blood cell count > 12,000/mm³) or leukopenia ( 10% hematocrit reduction). The diagnosis of SIRS requires at least two of these four clinical criteria. SIRS combined with an infectious source establishes the clinical definition of sepsis. ( 2 ) Sepsis-induced hypotension unresponsive to initial fluid resuscitation defines septic shock, a distributive shock state. Inflammatory mediators (e.g., histamine, serotonin, super-radicals, lysosomal enzymes) released in response to bacterial endotoxins increase capillary permeability and reduce peripheral vascular resistance, decreasing both afterload and preload due to third-spacing and diminished venous return. This leads to a reduced stroke volume, initially compensated by tachycardia, resulting in a hyperdynamic state characteristic of compensated septic shock. ( 1 ) Patients progressing to septic shock exhibit severe sepsis symptoms with hypotension. In early “compensated” shock, blood pressure may remain normal, but distributive shock signs—such as warm extremities, flash capillary refill (< 1 second), and bounding pulses (warm shock)—are evident. Aggressive fluid resuscitation and vasoactive support can reverse this stage. In uncompensated septic shock, hypotension persists, with signs including cool extremities, delayed capillary refill (> 3 seconds), and thready pulses (cold shock). Persistent tissue hypoperfusion may lead to irreversible shock, rapidly progressing to MODS and death. ( 3 ) Management includes administering broad-spectrum antibiotics within one hour of diagnosis, ensuring activity against likely pathogens and adequate tissue penetration. Source control, such as debridement of infected or necrotic tissue (e.g., cellulitis, abscesses, infected devices, or purulent wounds), is critical. ( 4 ) Within the first six hours, therapeutic goals include restoring central venous pressure (CVP) to 8–12 mmHg, mean arterial pressure (MAP) to > 65 mmHg, superior vena cava oxygen saturation to ≥ 70% or mixed venous saturation to ≥ 65%, and initiating fluid resuscitation with crystalloids (normal saline or albumin) or colloids (blood products) up to 80 mL/kg. Mechanical ventilation may reduce metabolic demand. ( 5 ) First-line vasoactive agents include epinephrine for cold shock and norepinephrine for warm shock; dopamine is no longer favored due to its suppression of the hypothalamic-pituitary-adrenal axis (prolactin and growth hormone), which may impair immune function. Corticosteroids are indicated for vasoactive-refractory shock or in patients with low basal cortisol levels (< 150 µg/L). ( 6 ) This study underscores the importance of understanding septic shock prevalence among adults, identifying primary causative factors, and pinpointing organ systems where sepsis initiates septic shock. It also highlights the need to identify high-risk patients to enable timely intervention. ( 7 ) Methods The study was conducted on 99 patients diagnosed with septic shock and admitted to Damascus National Hospital between April 1, 2023, and April 1, 2024. A comprehensive medical history was obtained from each patient to identify potential risk factors for septic shock. A multi-system clinical examination was performed to detect any clinical signs associated with septic shock. Laboratory investigations were requested, including complete blood count (CBC), blood glucose, creatinine, liver enzymes, urinalysis, and urine sediment. Additionally, blood cultures and cultures from suspected infection sites were performed, along with medical imaging to identify the source of septic shock or related complications. Patients were monitored for one month to assess prognosis. Statistical analysis was performed using SPSS-26, with a p-value < 0.05considered statistically significant. A detailed and thorough clinical history was obtained, including investigation of any prior risk factors. Comprehensive physical examinations were conducted. Extensive laboratory and imaging studies were performed, including: Complete blood count (CBC) and differential, Blood glucose, Renal and liver function tests, Arterial blood gases, Blood cultures, Urinalysis, Chest X-ray, Abdominal, pelvic, and cardiac ultrasound, CT scan and/or MRI when necessary, Endoscopy and other imaging modalities as indicated. Efforts were made to determine the infectious source and identify pathogenic microorganisms through blood cultures and site-specific cultures such as: Urine culture, Bronchial secretion culture, Ocular fluid culture, Skin sample culture, Cerebrospinal fluid (CSF) culture. Complications were assessed based on clinical, laboratory, and radiological findings. Patient outcomes were monitored for either death or recovery over a one-month follow-up period. Descriptive statistics for quantitative variables (mean ± SD) and qualitative variables (frequencies and percentages), Inferential statistics , including: Independent Student's t -test for comparing means, Chi-square test for association between qualitative variables, A significance level of p < 0.05 was considered, Data analysis was conducted using IBM SPSS. Results Demographic Distribution The study included 99 patients, The most common age group was 70–79 years (36.36%), followed by 60–69 years (33.33%), and 50–59 years (12.12%), Age groups 20–29, 30–39, and 40–49 each represented 6.06% (Table 1), Males constituted 39.4% of the sample, while females made up 60.6% (Table 1). Number of Risk Factors 51.51% of patients had three risk factors, 30.3% had two, 18.18% had one. (Table 2) Predisposing Risk Factors Aging, diabetes mellitus, and malignancies were the leading risk factors (81.81%), Followed by Chemotherapy, Invasive surgical procedures, Steroid use, Pregnancy and childbirth (each 18.18%), Other factors as listed in the (table 3). Site of Infection Most common: respiratory tract infections (30.30%), Followed by biliary tract infections (15.15%), Pyelonephritis (12.12%), Other sources detailed in the (table 4) Bacterial Culture Results All patients had ≥ 2 blood samples taken from different sites and each sample was ≥ 10 ml in Size, and Culture results were summarized in the Table 5. for Pathogens causing Septic shock, gram-positive bacteria accounted for 60% of cases, including staphylococcus aureus 20%, streptococcus pneumoniae 30%, B-hemolytic streptococcus 10%, while gram-negative bacteria represented in 30% of cases with Enterobacteriaceae 10%, Escherichia Coli 20%, and Fungi were represented in 10% of cases. (Table 6). For positive cultures from suspected infection sites, the results were as listed in Table 7, and pathogens isolated from the site of infection as listed in Table 8, and we observe that the results were positive in 27.27% and the distribution of pathogens was relatively balanced between Gram-positive (55.55%) and Gram-negative (44.44%) bacteria. Staphylococcus aureus were isolated from skin and soft tissue sample, B-hemolytic streptococcus from skin samples and streptococcus pneumoniae from bronchial secretion, E-Coli from urine and ascitic fluid, pseudomonas aerginosa from urine and bronchial secretions. In 6 patients, blood culture results matched the primary infection site culture: 4 patients with pyelonephritis and 2 patients with complicated peritonitis. SIRS Clinical Indicators At least two clinical or laboratory criteria were required for diagnosis, Distribution of signs and symptoms presented in a table (9) Complications Acute kidney injury (AKI) was the most common complication and Other complications were recorded in the table 10. Management Immediate management upon diagnosis aimed to ensure adequate oxygenation, maintain intravascular volume, and achieve hemodynamic stability using vasopressors, Empiric antibiotics were administered promptly based on the suspected source of infection, patient immunity, comorbidities, and whether infection was community- or hospital-acquired, Antibiotic regimens were adjusted based on culture results or unexpected reactions. (Table 11) We observe that the antibiotics most frequently administered to patients were ceftriaxone (100%) and Amoxicillin – clavulanic acid (54.54%). Some patients received multiple antibiotics from the same class, however, this did not occur simultaneously but rather represented sequential changes in the treatment plan at different time point. Prognosis and Outcome Death occurred in 93 patients (93.93%), Recovery in 6 patients (6.06%): 3 with pyelonephritis, 3 with predictive bladder conditions. (Table 12) Correlation between Age and Gender Septic shock incidence increased after age 50 (81 patients, 81.81%), 18 patients (18.18%) were under 50, Higher incidence in females under 40 (12.12%) with none in males, likely due to pregnancy-related complications. (Table 13) Correlation between Risk Factors and Gender: Most common risk factors in both genders were: Age >50: 36.36% in males, 45.45% in females. Diabetes mellitus: 24.24% in males, 30.3% in females. (Table 14) Correlation between Number of Risk Factors and Gender: Higher number of risk factors correlated with increased incidence of septic shock, One factor 18.18%, Three or more 51.51%. (Table 15) Correlation between infection site and gender Pneumonia was the most prevalent source of sepsis in both gender, males 18.18% and females 12.12%. urinary tract infections and biliary tract infections showed equal prevalence: each accounted for 15.15% of cases in both male and female patients. (Table 16) Discussion Septic shock was diagnosed in 33 patients over a year at Damascus Hospital, Female incidence (60.6%) was higher than male (39.4%), in contrast to global data where males are more affected (~60%)—possibly due to pregnancy-related complications. Shock incidence increased with age; 81.81% were over 50, consistent with global data (~78%). Diabetes mellitus and age >50 were the most common risk factors. Respiratory infections were the most frequent source of sepsis (30.30%), followed by urinary and biliary tract infections. Blood cultures were positive in only 30.30% compared to 50% globally—possibly due to prior antibiotic use or fastidious organisms. AKI was universal in this cohort (100%) vs. 6.06% globally—likely due to comorbidities like diabetes. Mortality rate was 93.93%, significantly higher than global rates (60–70%)—likely due to lack of optimal care, including isolation rooms and specialized medical teams. Recommendations Increase public awareness and education about sepsis and septic shock, especially for immunocompromised and at-risk individuals. Avoid underestimating infections in vulnerable patients; implement proper microbial cultures and sensitivity testing before initiating antibiotics. Regulate antibiotic use and enforce prescription-only policies, especially for parenteral and broad-spectrum agents. Establish specialized centers for severe sepsis and septic shock with isolation facilities and trained medical teams. Ensure immunocompromised patients are isolated appropriately during hospitalization for primary illnesses. Declarations Autor Contributions Sami conceptualized the study, analyzed the data and wrote the original draft of the manuscript, Nizar was the supervisor, Sami and Nizar read and approved the final manuscript, Haidar was involved in the magazine's correspondence. Funding Not applicable Clinical trial number Not applicable All participants agreed to participate in the study, and provided verbal or written informed consent Ethics approval and consent to participate This research was carried out in accordance with the precepts of the Declaration of Helsinki and the Nuremberg Code, respecting the Standards for Research Involving Human Beings. In compliance with Resolution No. 466, of December 12, 2012, of the National Health Council - CNS, which includes the Guidelines and Regulatory Norms for Research involving human beings, Ethics approval and consent to participate. The study was approved by the Ethics commiittee of Federal University of Rio Grande– FURG (Opinion: 4.375.697/ CAAE: 39081120.0.0000.5324 “ under Ethics approval and consent to participate section. The participants were provided with detailed information on the research, including its objectives, procedures, potential risks, and benefits. Additionally, they were informed about their right to withdraw from the study at any time without repercussion. All participants agreed to participate in the study, and provided verbal or written consent. Data availability The data supporting this study's findings cannot be made publicly available to protect (patient confidentiality / sensitive information / proprietary rights). However, anonymized or limited data may be shared with qualified researches subject to approval by "the ethics committee". Requests should be directed to corresponding author's email. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Nguyen HB, Rivers EP, Abrahamian FM, Moran GJ, Abraham E, Trzeciak S, Huang DT, Osborn T, Stevens D, Talan DA., Emergency Department Sepsis Education Program and Strategies to Improve Survival (ED-SEPSIS) Working Group. Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Ann Emerg Med. 2006 Jul;48(1):28-54. [PubMed] Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. [PubMed] Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K., EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009 Dec 02;302(21):2323-9. [PubMed] Rangel-Frausto MS. The epidemiology of bacterial sepsis. Infect Dis Clin North Am. 1999 Jun;13(2):299-312, vii. [PubMed] Annane D. Corticosteroids for septic shock. Crit Care Med. 2001 Jul;29(7 Suppl):S117-20. [PubMed] Annane D, Renault A, Bellissant E. Glucocorticoids with or without Fludrocortisone in Septic Shock. N Engl J Med. 2018 Aug 30;379(9):895-6. [PubMed] o AE, Bell D, Bellomo R, Chong CR, Coats TJ, Davies A, Delaney A, Harrison DA, Holdgate A, Howe B, Huang DT, Iwashyna T, Kellum JA, Peake SL, Pike F, Reade MC, Rowan KM, Singer M, Webb SA, Weissfeld LA, Yealy DM, Young JD. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Tables Table 1. Demographic Data Age Number of patients Percentage 20-29 years 6 6.06% 30-39 years 6 6.06% 40-49 years 6 6.06% 50-59 years 12 12.12% 60-69 years 33 33.33% 70-79 years 36 36.36% Gender Male 39 39.4% Female 60 60.6% Table 2. Risk Factors Number of Factors N of patients P (%) 1 18 18.18% 2 30 30.3% 3 51 51.51% Table 3. The risk factors predisposing to septic shock Factor Number of Patients Percentage Age > 50 years 81 81.81% Diabetes 54 54.54% Cancer 18 18.18% Chemotherapy 15 15.15% Surgery and invasive procedures 15 15.15% Steroids 12 12.12% Pregnancy 12 12.12% Liver cirrhosis 9 9.09% Chronic renal failure 6 6.06% Long term antibiotic use 3 3.03% Malnutrition 3 3.03% Table 4. the site of infection in patients with septic shock N P Urinary System Pyelonephritis 12 12.12% Abscess 3 3.03% Pneumonia 30 30.30% Female reproductive system 9 9.09% Cholangitis 15 15.15% Peritonitis 18 18.18% Skin and soft tissue infection 9 9.09% Not identified 3 3.03% Table 5. blood culture Result N P (%) Positive 30 30.03% Negative 69 69.7% Table 6. pathogens causing septic shock Pathogen N Percentage of culture positive Percentage according of Gram stain Gram-positive Staphylococcus 6 20% 60% Pneumococcic 9 30% B-hemolytic streptococci 3 10% Gram- negative Enterococci 3 10% 30% E-coli 6 20% Fungi - 3 10% 10% Table 7. bacterial culture of infection site N P (%) Positive 27 27.27% Negative 72 72.72% Table 7. pathogens isolated from infections site Pathogen N Percentage of culture positive Percentage according of Gram stain Gram-positive Staphylococcus 6 22.22% 60% Pneumococcic 6 22.22% B-hemolytic streptococci 3 11.11% Gram- negative Pseudomonas 6 22.22% 44.44% E-coli 6 22.22% Table 9. clinical and laboratory sings of SIRS N P (%) Tachypnea ( > 20/ min) 99 100% Tachycardia ( > 90 / min) 99 100% Fever ( > 38 0 C) 84 84.84% Hypothermia ( 12 x 10 9 / L 66 66.66% WBC < 4 x 10 9 / L 12 12.12% Table 10. complications N P (%) Acute renal injury 99 100% Cerebral dysfunction 60 60.60% ARDS 24 24.24% DIC 21 21.21% Acute liver failure 12 12.12% Heart failure 12 12.12% Table 11. antibiotics N P (%) Ceftriaxone 99 100% Amoxicillin + clavulanic acid 54 54.54% Metronidazole 21 21.21% Ceftazidime 18 18.18% Vancomycin 15 15.15% Amikacin 12 12.12% Teicoplanin 12 12.12% Gentamicin 9 9.09% Ciprofloxacin 9 9.09% Cefotaxime 9 9.09% Cefepime 6 6.06% Clarithromycin 6 6.06% Penicillin G 6 6.06% Imipenem 3 3.03% Clindamycin 3 3.03% Table 12. Prognosis N P (%) Recovery 6 6.06% Mortality 93 93.93% Table 13. the correlation between age, gender and septic shock Age Male Female P-value 20-29 years 0 (0%) 6 (6.06%) 0.032 30-39 years 0 (0%) 6 (6.06%) 40-49 years 3 (3.03%) 3 (3.03%) 50-59 years 6 (6.06%) 6 (6.06%) 60-69 years 12 (12.12%) 21 (21.21%) 70-79 years 18 (18.18%) 18 (18.18%) Table 14. The correlation between risk factors and Gender and septic shock Factor Male Female P-value Age > 50 years 36 (36.36%) 45 (45.45%) 0.006 Diabetes 24 (24.24%) 30 (30.3%) Cancer 12 (12.12%) 6 (6.06%) Chemotherapy 12 (12.12%) 3 (3.03%) Surgery and invasive procedures 6 (6.06%) 9 (9.09%) Steroids 9 (9.09%) 3 (3.03%) Pregnancy 0 (0%) 12 (12.12%) Liver cirrhosis 6 (6.06%) 3 (3.03%) Chronic renal failure 3 (3.03%) 3 (3.03%) Long term antibiotic use 0 (0%) 3 (3.03%) Malnutrition 0 (0%) 3 (3.03%) Table15. the correlation between number of risk factors and septic shock Number of Factors Male Female P-value 1 6 (6.06%) 12 (12.12%) 0.008 2 9 (9.09%) 21 (21.21%) 3 24 (24.24%) 27 (27.27%) Table 16. the correlation between site of infection and gender and septic shock Male Female p-value Urinary System Pyelonephritis 6 (6.06%) 6 (6.06%) 0.003 Abscess 3 (3.03%) 0 (0%) Pneumonia 12 (12.12%) 18 (18.18%) Female reproductive system 0 (0%) 9 (9.09%) Cholangitis 6 (6.06%) 9 (9.09%) Peritonitis 9 (9.09%) 9 (9.09%) Skin and soft tissue infection 3 (3.03%) 6 (6.06%) Not identified 0 (0%) 3 (3.03%) 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-6582501","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":467041757,"identity":"1ba38497-b4d9-44b7-898e-7d7220876a68","order_by":0,"name":"Sami Yaser Dib","email":"","orcid":"","institution":"Syrian Private University","correspondingAuthor":false,"prefix":"","firstName":"Sami","middleName":"Yaser","lastName":"Dib","suffix":""},{"id":467041758,"identity":"9452f34e-4ca8-4675-bbcd-664ae0d4193a","order_by":1,"name":"Nizar Al-Daher","email":"","orcid":"","institution":"Al-Mouwasat University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nizar","middleName":"","lastName":"Al-Daher","suffix":""},{"id":467041759,"identity":"6e5fa36e-f180-4827-9fe0-83e41490da1e","order_by":2,"name":"Haidar Yousef","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABI0lEQVRIiWNgGAWjYBACAwbGBgkY58MHAxs7fhAroYA4LYwzZ1SkJUs2gLQY4NPCwADXMpvnzGHGDQdg4jiAOfvhxhs/9xyWMzh/+GADbxszs/H51YkfHhgwyPOLHcCqxbInsdmy59lhY4MbaYkNkm1sfGY33m6WADrMcObsBOwOO5DYJsFz4HDihhs85g8M23iYzW6c3QDSkmBwG4eW8w/bJP+AtJw//7EBqJ1x84yzm3/g1XIjsU0abMuBHMaGA2cMGDfw927Db8uNh83WMgfSjSVvpBk2NlQkJEvc4N1mkWAggdsv59Mf3nxzwFqO7/zhh81/DP7b8fef3XzzR4WNPL80di1Q0IzElgCrlMCuEAHqkNj8BwipHgWjYBSMghEGAK65bkcl3oCEAAAAAElFTkSuQmCC","orcid":"","institution":"Al-Mouwasat University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Haidar","middleName":"","lastName":"Yousef","suffix":""}],"badges":[],"createdAt":"2025-05-03 07:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6582501/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6582501/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98427651,"identity":"f78c44b5-9fcd-4dde-b1dc-8649d6f55ee8","added_by":"auto","created_at":"2025-12-17 16:40:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":736324,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6582501/v1/04694e38-1a1e-4321-b9d5-375c4ee941ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Study of Risk Factors and Prognosis in Patients with Septic Shock admitted to Damascus National Hospital, Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSepsis represents a clinical continuum of pathophysiological states, progressing from systemic inflammatory response syndrome (SIRS) to multiorgan dysfunction syndrome (MODS) and, ultimately, death. Initial inflammatory manifestations include fever (temperature\u0026thinsp;\u0026gt;\u0026thinsp;38\u0026deg;C) or hypothermia (\u0026lt;\u0026thinsp;36\u0026deg;C), tachycardia (heart rate\u0026thinsp;\u0026gt;\u0026thinsp;90 beats/min), tachypnea (respiratory rate\u0026thinsp;\u0026gt;\u0026thinsp;20 breaths/min), and leukocytosis (white blood cell count\u0026thinsp;\u0026gt;\u0026thinsp;12,000/mm\u0026sup3;) or leukopenia (\u0026lt;\u0026thinsp;4,000/mm\u0026sup3;), with or without anemia (\u0026gt;\u0026thinsp;10% hematocrit reduction). The diagnosis of SIRS requires at least two of these four clinical criteria. SIRS combined with an infectious source establishes the clinical definition of sepsis. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSepsis-induced hypotension unresponsive to initial fluid resuscitation defines septic shock, a distributive shock state. Inflammatory mediators (e.g., histamine, serotonin, super-radicals, lysosomal enzymes) released in response to bacterial endotoxins increase capillary permeability and reduce peripheral vascular resistance, decreasing both afterload and preload due to third-spacing and diminished venous return. This leads to a reduced stroke volume, initially compensated by tachycardia, resulting in a hyperdynamic state characteristic of compensated septic shock. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ePatients progressing to septic shock exhibit severe sepsis symptoms with hypotension. In early \u0026ldquo;compensated\u0026rdquo; shock, blood pressure may remain normal, but distributive shock signs\u0026mdash;such as warm extremities, flash capillary refill (\u0026lt;\u0026thinsp;1 second), and bounding pulses (warm shock)\u0026mdash;are evident. Aggressive fluid resuscitation and vasoactive support can reverse this stage. In uncompensated septic shock, hypotension persists, with signs including cool extremities, delayed capillary refill (\u0026gt;\u0026thinsp;3 seconds), and thready pulses (cold shock). Persistent tissue hypoperfusion may lead to irreversible shock, rapidly progressing to MODS and death. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eManagement includes administering broad-spectrum antibiotics within one hour of diagnosis, ensuring activity against likely pathogens and adequate tissue penetration. Source control, such as debridement of infected or necrotic tissue (e.g., cellulitis, abscesses, infected devices, or purulent wounds), is critical. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWithin the first six hours, therapeutic goals include restoring central venous pressure (CVP) to 8\u0026ndash;12 mmHg, mean arterial pressure (MAP) to \u0026gt;\u0026thinsp;65 mmHg, superior vena cava oxygen saturation to \u0026ge;\u0026thinsp;70% or mixed venous saturation to \u0026ge;\u0026thinsp;65%, and initiating fluid resuscitation with crystalloids (normal saline or albumin) or colloids (blood products) up to 80 mL/kg. Mechanical ventilation may reduce metabolic demand. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFirst-line vasoactive agents include epinephrine for cold shock and norepinephrine for warm shock; dopamine is no longer favored due to its suppression of the hypothalamic-pituitary-adrenal axis (prolactin and growth hormone), which may impair immune function. Corticosteroids are indicated for vasoactive-refractory shock or in patients with low basal cortisol levels (\u0026lt;\u0026thinsp;150 \u0026micro;g/L). (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis study underscores the importance of understanding septic shock prevalence among adults, identifying primary causative factors, and pinpointing organ systems where sepsis initiates septic shock. It also highlights the need to identify high-risk patients to enable timely intervention. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was conducted on 99 patients diagnosed with septic shock and admitted to Damascus National Hospital between April 1, 2023, and April 1, 2024. A comprehensive medical history was obtained from each patient to identify potential risk factors for septic shock. A multi-system clinical examination was performed to detect any clinical signs associated with septic shock. Laboratory investigations were requested, including complete blood count (CBC), blood glucose, creatinine, liver enzymes, urinalysis, and urine sediment. Additionally, blood cultures and cultures from suspected infection sites were performed, along with medical imaging to identify the source of septic shock or related complications. Patients were monitored for one month to assess prognosis. Statistical analysis was performed using SPSS-26, with a p-value \u0026lt; 0.05considered statistically significant. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA detailed and thorough clinical history was obtained, including investigation of any prior risk factors. Comprehensive physical examinations were conducted. Extensive laboratory and imaging studies were performed, including:\u0026nbsp;Complete blood count (CBC) and differential, Blood glucose, Renal and liver function tests, Arterial blood gases, Blood cultures, Urinalysis, Chest X-ray, Abdominal, pelvic, and cardiac ultrasound, CT scan and/or MRI when necessary, Endoscopy and other imaging modalities as indicated.\u003c/p\u003e\n\u003cp\u003eEfforts were made to determine the infectious source and identify pathogenic microorganisms through blood cultures and site-specific cultures such as:\u0026nbsp;Urine culture, Bronchial secretion culture, Ocular fluid culture, Skin sample culture, Cerebrospinal fluid (CSF) culture.\u0026nbsp;Complications were assessed based on clinical, laboratory, and radiological findings. Patient outcomes were monitored for either death or recovery over a one-month follow-up period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescriptive statistics\u003c/strong\u003e for quantitative variables (mean \u0026plusmn; SD) and qualitative variables (frequencies and percentages), \u003cstrong\u003eInferential statistics\u003c/strong\u003e, including: \u0026nbsp;Independent Student\u0026apos;s \u003cem\u003et\u003c/em\u003e-test for comparing means, Chi-square test for association between qualitative variables, A significance level of \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 was considered, Data analysis was conducted using IBM SPSS.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic Distribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 99 patients, The most common age group was 70–79 years (36.36%), followed by 60–69 years (33.33%), and 50–59 years (12.12%), Age groups 20–29, 30–39, and 40–49 each represented 6.06% (Table 1), Males constituted 39.4% of the sample, while females made up 60.6% (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of Risk Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e51.51% of patients had three risk factors, 30.3% had two, 18.18% had one. (Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredisposing Risk Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAging, diabetes mellitus, and malignancies were the leading risk factors (81.81%), Followed by Chemotherapy, Invasive surgical procedures, Steroid use, Pregnancy and childbirth (each 18.18%), Other factors as listed in the (table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSite of Infection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost common: respiratory tract infections (30.30%), Followed by biliary tract infections (15.15%), Pyelonephritis (12.12%), Other sources detailed in the (table 4)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBacterial Culture Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients had \u0026nbsp;≥ 2 blood samples taken from different sites and each sample was \u0026nbsp;≥ 10 ml in Size, and Culture results were summarized in the Table 5. for Pathogens causing Septic shock, gram-positive bacteria accounted for 60% of cases, including staphylococcus aureus 20%, streptococcus pneumoniae 30%, B-hemolytic streptococcus 10%, while gram-negative bacteria represented in 30% of cases with Enterobacteriaceae 10%, Escherichia Coli 20%, and Fungi were represented in 10% of cases. (Table 6).\u003c/p\u003e\n\u003cp\u003eFor positive cultures from suspected infection sites, the results were as listed in Table 7, and pathogens isolated from the site of infection as listed in Table 8, and we observe that the results were positive in 27.27% and the distribution of pathogens was relatively balanced between Gram-positive (55.55%) and Gram-negative (44.44%) bacteria. Staphylococcus aureus were isolated from skin and soft tissue sample, B-hemolytic streptococcus from skin samples and streptococcus pneumoniae from bronchial secretion, E-Coli from urine and ascitic fluid, pseudomonas aerginosa from urine and bronchial secretions. In 6 patients, blood culture results matched the primary infection site culture: 4 patients with pyelonephritis and 2 patients with complicated peritonitis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSIRS Clinical Indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt least two clinical or laboratory criteria were required for diagnosis, Distribution of signs and symptoms presented in a table (9)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcute kidney injury (AKI) was the most common complication and Other complications were recorded in the table 10.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eImmediate management upon diagnosis aimed to ensure adequate oxygenation, maintain intravascular volume, and achieve hemodynamic stability using vasopressors, Empiric antibiotics were administered promptly based on the suspected source of infection, patient immunity, comorbidities, and whether infection was community- or hospital-acquired, Antibiotic regimens were adjusted based on culture results or unexpected reactions. (Table 11)\u003c/p\u003e\n\u003cp\u003eWe observe that the antibiotics most frequently administered to patients were ceftriaxone (100%) and Amoxicillin – clavulanic acid (54.54%). Some patients received multiple antibiotics from the same class, however, this did not occur simultaneously but rather represented sequential changes in the treatment plan at different time point.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrognosis and Outcome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeath occurred in 93 patients (93.93%), Recovery in 6 patients (6.06%): 3 with pyelonephritis, 3 with predictive bladder conditions. (Table 12)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation between Age and Gender\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeptic shock incidence increased after age 50 (81 patients, 81.81%), 18 patients (18.18%) were under 50, Higher incidence in females under 40 (12.12%) with none in males, likely due to pregnancy-related complications. (Table 13)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation between Risk Factors and Gender:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost common risk factors in both genders were: Age \u0026gt;50: 36.36% in males, 45.45% in females. Diabetes mellitus: 24.24% in males, 30.3% in females. (Table 14)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation between Number of Risk Factors and Gender:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigher number of risk factors correlated with increased incidence of septic shock, One factor 18.18%, Three or more 51.51%. (Table 15)\u003c/p\u003e\n\u003cp\u003eCorrelation between infection site and gender\u003c/p\u003e\n\u003cp\u003ePneumonia was the most prevalent source of sepsis in both gender, males 18.18% and females 12.12%. urinary tract infections and biliary tract infections showed equal prevalence: each accounted for 15.15% of cases in both male and female patients. (Table 16)\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSeptic shock was diagnosed in 33 patients over a year at Damascus Hospital, Female incidence (60.6%) was higher than male (39.4%), in contrast to global data where males are more affected (~60%)—possibly due to pregnancy-related complications. Shock incidence increased with age; 81.81% were over 50, consistent with global data (~78%). Diabetes mellitus and age \u0026gt;50 were the most common risk factors. Respiratory infections were the most frequent source of sepsis (30.30%), followed by urinary and biliary tract infections. Blood cultures were positive in only 30.30% compared to 50% globally—possibly due to prior antibiotic use or fastidious organisms. AKI was universal in this cohort (100%) vs. 6.06% globally—likely due to comorbidities like diabetes. Mortality rate was 93.93%, significantly higher than global rates (60–70%)—likely due to lack of optimal care, including isolation rooms and specialized medical teams.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIncrease public awareness and education about sepsis and septic shock, especially for immunocompromised and at-risk individuals. Avoid underestimating infections in vulnerable patients; implement proper microbial cultures and sensitivity testing before initiating antibiotics. Regulate antibiotic use and enforce prescription-only policies, especially for parenteral and broad-spectrum agents. Establish specialized centers for severe sepsis and septic shock with isolation facilities and trained medical teams. Ensure immunocompromised patients are isolated appropriately during hospitalization for primary illnesses.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAutor Contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSami conceptualized the study, analyzed the data and wrote the original draft of the manuscript, Nizar was the supervisor, Sami and Nizar read and approved the final manuscript, Haidar was involved in the magazine\u0026apos;s correspondence.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eClinical trial number\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAll participants agreed to participate in the study, and provided verbal or written informed consent\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research was carried out in accordance with the precepts of the Declaration of Helsinki and the Nuremberg Code, respecting the Standards for Research Involving Human Beings. In compliance with Resolution No. 466, of December 12, 2012, of the National Health Council - CNS, which includes the Guidelines and Regulatory Norms for Research involving human beings, Ethics approval and consent to participate. The study was approved by the \u0026nbsp; Ethics commiittee of Federal University of Rio Grande\u0026ndash; FURG (Opinion: 4.375.697/ CAAE: 39081120.0.0000.5324 \u0026ldquo; under Ethics approval and consent to participate section. The participants were provided with detailed information on the research, including its objectives, procedures, potential risks, and benefits. Additionally, they were informed about their right to withdraw from the study at any time without repercussion. All participants agreed to participate in the study, and provided verbal or written consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData availability\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data supporting this study\u0026apos;s findings cannot be made publicly available to protect (patient confidentiality / sensitive information / proprietary rights). However, anonymized or limited data may be shared with qualified researches subject to approval by \u0026quot;the ethics committee\u0026quot;. Requests should be directed to corresponding author\u0026apos;s email. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNguyen HB, Rivers EP, Abrahamian FM, Moran GJ, Abraham E, Trzeciak S, Huang DT, Osborn T, Stevens D, Talan DA., Emergency Department Sepsis Education Program and Strategies to Improve Survival (ED-SEPSIS) Working Group. Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Ann Emerg Med. 2006 Jul;48(1):28-54. [PubMed]\u003c/li\u003e\n\u003cli\u003eBone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. [PubMed]\u003c/li\u003e\n\u003cli\u003eVincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K., EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009 Dec 02;302(21):2323-9. [PubMed]\u003c/li\u003e\n\u003cli\u003eRangel-Frausto MS. The epidemiology of bacterial sepsis. Infect Dis Clin North Am. 1999 Jun;13(2):299-312, vii. [PubMed]\u003c/li\u003e\n\u003cli\u003eAnnane D. Corticosteroids for septic shock. Crit Care Med. 2001 Jul;29(7 Suppl):S117-20. [PubMed]\u003c/li\u003e\n\u003cli\u003eAnnane D, Renault A, Bellissant E. Glucocorticoids with or without Fludrocortisone in Septic Shock. N Engl J Med. 2018 Aug 30;379(9):895-6. [PubMed]\u003c/li\u003e\n\u003cli\u003eo AE, Bell D, Bellomo R, Chong CR, Coats TJ, Davies A, Delaney A, Harrison DA, Holdgate A, Howe B, Huang DT, Iwashyna T, Kellum JA, Peake SL, Pike F, Reade MC, Rowan KM, Singer M, Webb SA, Weissfeld LA, Yealy DM, Young JD. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 1. Demographic Data\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAge\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNumber of patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e20-29 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e30-39 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e40-49 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e50-59 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e60-69 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e33.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e70-79 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e36.36%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGender\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eMale\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e39.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eFemale\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e60.6%\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=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 2. Risk Factors\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eNumber of Factors\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eN of patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eP (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e18.18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e2\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e30.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e3\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e51.51%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 3. The risk factors predisposing to septic shock\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eFactor\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eNumber of Patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eAge \u0026gt; 50 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e81.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eDiabetes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e54.54%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eCancer\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e18.18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eChemotherapy\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e15.15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eSurgery and invasive procedures\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e15.15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eSteroids\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e12.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003ePregnancy\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e12.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eLiver cirrhosis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e9.09%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eChronic renal failure\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e6.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eLong term antibiotic use\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e3.03%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cem\u003eMalnutrition\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e3.03%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 4. the site of infection in patients with septic shock\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cem\u003eUrinary System\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003ePyelonephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e12.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eAbscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3.03%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cem\u003ePneumonia\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e30.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cem\u003eFemale reproductive system\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e9.09%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cem\u003eCholangitis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e15.15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cem\u003ePeritonitis\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e18.18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cem\u003eSkin and soft tissue infection\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e9.09%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cem\u003eNot identified\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3.03%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 5. blood culture\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eResult\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eN\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eP (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003ePositive\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e30.03%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eNegative\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e69.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 6. pathogens causing septic shock\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003ePathogen\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003ePercentage of culture positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ePercentage according of Gram stain\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cem\u003eGram-positive\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eStaphylococcus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003ePneumococcic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eB-hemolytic streptococci\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cem\u003eGram- negative\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eEnterococci\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eE-coli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cem\u003eFungi\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 7. bacterial culture of infection site\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eN\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eP (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003ePositive\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e27.27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eNegative\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e72.72%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 7. pathogens isolated from infections site\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003ePathogen\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003ePercentage of culture positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003ePercentage according of Gram stain\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cem\u003eGram-positive\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eStaphylococcus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e22.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 151px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003ePneumococcic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e22.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eB-hemolytic streptococci\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e11.11%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cem\u003eGram- negative\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003ePseudomonas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e22.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003e44.44%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eE-coli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e22.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 9. clinical and laboratory sings of SIRS\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eP (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eTachypnea ( \u0026gt; 20/ min)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eTachycardia ( \u0026gt; 90 / min)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eFever ( \u0026gt; 38\u003csup\u003e\u0026nbsp;0\u003c/sup\u003eC)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e84.84%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eHypothermia (\u0026lt; 36 \u003csup\u003e0\u003c/sup\u003eC)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eWBC \u0026gt; 12 x 10\u003csup\u003e9\u003c/sup\u003e/ L\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e66.66%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eWBC \u0026lt; 4 x 10\u003csup\u003e9\u003c/sup\u003e / L\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 10. complications\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eP (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eAcute renal injury \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eCerebral dysfunction\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e60.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eARDS\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e24.24%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eDIC\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e21.21%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eAcute liver failure\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eHeart failure\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 11. antibiotics\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eP (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eCeftriaxone\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eAmoxicillin + clavulanic acid\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e54.54%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eMetronidazole\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e21.21%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eCeftazidime\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e18.18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eVancomycin\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e15.15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eAmikacin\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eTeicoplanin\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eGentamicin\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e9.09%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eCiprofloxacin\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e9.09%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eCefotaxime\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e9.09%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eCefepime\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eClarithromycin\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003ePenicillin G\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eImipenem\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e3.03%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cem\u003eClindamycin \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e3.03%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 12. Prognosis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eP (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eRecovery\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e6.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eMortality\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e93.93%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 13. the correlation between age, gender and septic shock\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003eAge\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e20-29 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e30-39 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e40-49 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e50-59 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e60-69 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (12.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e21 (21.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e70-79 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (18.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (18.18%)\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=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 604px;\"\u003e\n \u003cp\u003eTable \u003cem\u003e14. The correlation between risk factors and Gender and septic shock\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eFactor\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eAge \u0026gt; 50 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e36 (36.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e45 (45.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"11\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eDiabetes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e24 (24.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e30 (30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eCancer\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e12 (12.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eChemotherapy\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e12 (12.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eSurgery and invasive procedures\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e9 (9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eSteroids\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e9 (9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003ePregnancy\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e12 (12.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eLiver cirrhosis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eChronic renal failure\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eLong term antibiotic use\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eMalnutrition\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable15. the correlation between number of risk factors and septic shock\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003eNumber of Factors\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e12 (12.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e2\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e9 (9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e21 (21.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cem\u003e3\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e24 (24.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e27 (27.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 16. the correlation between site of infection and gender and septic shock\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cem\u003eUrinary System\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003ePyelonephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"8\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003eAbscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003ePneumonia\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e12 (12.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e18 (18.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003eFemale reproductive system\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e9 (9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003eCholangitis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e9 (9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003ePeritonitis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e9 (9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e9 (9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003eSkin and soft tissue infection\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e6 (6.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003eNot identified\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e3 (3.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\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, risk factor, prognosis, mortality, recover","lastPublishedDoi":"10.21203/rs.3.rs-6582501/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6582501/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSeptic shock, the most severe complication of sepsis, is a life-threatening condition characterized by profound circulatory, cellular, and metabolic dysfunction. It carries a high mortality rate worldwide, particularly in resource-limited settings where delayed diagnosis, inadequate antimicrobial stewardship, and limited critical care infrastructure exacerbate outcomes. In Syria, the ongoing socioeconomic crisis has severely impacted healthcare delivery, with rising infectious disease burdens, antibiotic resistance, and suboptimal management of sepsis.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study aims to identify the key risk factors, infection sources, and mortality predictors of septic shock among patients admitted to Damascus National Hospital, providing critical insights into ist epidemiology and outcomes in a crisis-affected population.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study was conducted on 99 patients diagnosed with septic shock and admitted to Damascus National Hospital between April 1, 2023, and April 1, 2024. A comprehensive medical history was obtained from each patient to identify potential risk factors for septic shock. A multi-system clinical examination was performed, Laboratory investigations were requested, including complete blood count (CBC), blood glucose, creatinine, liver enzymes, urinalysis, blood cultures and cultures from suspected infection sites along with medical imaging to identify the source of septic shock or related complications. Patients were monitored for one month to assess prognosis. Statistical analysis was performed using SPSS-26 with a p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05 considered statistically significant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSeptic shock was more common in females than males, with increased risk in advanced age (\u0026gt;\u0026thinsp;50 years). The most frequently observed risk factors were advanced age (\u0026gt;\u0026thinsp;50), diabetes mellitus, and poor patient compliance with treatment in our society. The risk of septic shock significantly increased with a higher number of risk factors per patient. Pulmonary infections were the most common source of infection leading to septic shock. Mortality occurred in the majority of patients (93.93%), indicating a poor prognosis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOur study demonstrates that septic shock is a serious complication in our society, primarily associated with post-infectious mortality. Regardless of risk factors, the survival rate does not exceed 3%, attributed to antibiotic misuse, rising antibiotic resistance, and inadequate medical services and healthcare** due to the country\u0026rsquo;s deteriorating economic conditions.\u003c/p\u003e","manuscriptTitle":"Study of Risk Factors and Prognosis in Patients with Septic Shock admitted to Damascus National Hospital, Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-06 16:22:27","doi":"10.21203/rs.3.rs-6582501/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":"58153de7-f810-4aa3-8593-8cc0d235c5ef","owner":[],"postedDate":"June 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-12T05:54:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-06 16:22:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6582501","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6582501","identity":"rs-6582501","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}