Prognostic factors associated with mortality in septic shock: a systematic review and meta-analysis.

In this systematic reviewand meta-analysis, we aimed to identify prognostic factors of early mortality in septic shock.

在这项系统评价和荟萃分析中，我们的目标是识别脓毒症性休克早期死亡的预后因素。

Methods

A systematic reviewand meta-analysisof prognostic factors associated with early mortality in septic shock was performed.

对与脓毒症休克早期死亡相关的预后因素进行了系统评价和荟萃分析。

MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from database inception to Aug 13, 2025, were searched.

从数据库创建开始到2025年8月13日，对MEDLINE、Embase和Cochrane中央控制试验登记处进行了搜索。

All observational and randomised controlled trialstudies that evaluated prognostic factors and early mortality (in-hospital or up to 31-days) in septic shock were included.

所有评估脓毒症休克预后因素和早期死亡率（住院期间或最多31天内）的观察性和随机对照试验研究都被纳入。

Studies were excluded if they evaluated children or were post-mortem studies.

如果研究对象为儿童或为死后研究，则被排除。

Title and abstracts were reviewed by two independent reviewers.

标题和摘要由两位独立评审员进行了审查。

Summary data were extracted from published reports.

摘要数据是从已发表的报告中提取的。

The primary objective was to evaluate prognostic factors associated with mortality, reported as adjusted odds ratios (OR) using generic inverse variance method and random effects model and variables were significant if the p value was less than 0·05.

主要目标是评估与死亡率相关的预后因素，报告为调整后的优势比（OR），使用通用逆方差法和随机效应模型，如果P值小于0.05，则变量具有统计学意义。

This study was registered with Open Science Framework (OSF: 10.17605/OSF.IO/75H4G).

该研究已在开放科学框架（OSF: 10.17605/OSF.IO/75H4G）上注册。

Results

Of 6814 records identified by our search, 1420 articles were assessed for full-text review, of these, 95 studies of 4 831 379 patients were included.

我们的检索共识别出6814条记录，其中1420篇文章被评估为全文审查，这些文章中，有95项研究涉及4,831,379名患者被纳入。

Of 95 included studies, 90 (95%) were observational studies and five (5%) were randomised controlled trials.

在纳入的95项研究中，有90项（95%）是观察性研究，五项（5%）是随机对照试验。

In 4 831 379 patients, the mean age was 64 years, 58% of participants were male, 42% were female, and early hospital mortality occurred in 1 606 384 patients (33·2% [IQR 29·5-37·3]).

在4,831,379名患者中，平均年龄为64岁，58%的参与者为男性，42%为女性，且有1,606,384名患者（33.2% [四分位数间距 29.5-37.3]）在入院早期死亡。

Patient factors significantly associated with increased mortality included increasing age (adjusted OR 1·02 per 1 year [95% CI 1·01-1·02; I2 =64%; moderate certainty), Black race (1·23 [1·21-1·25]; I2 =0%; moderate certainty), hepatic cirrhosis (1·85 [1·64-2·08]; I2 =0%; high certainty), malignancy (1·43 [1·09-1·88]; I2 =91%; high certainty), and increased Charlson comorbidity index (1·22 per point [1·19-1·25]; I2 =0%; high certainty).

与死亡率增加显著相关的患者因素包括年龄增长（调整后的OR为每增加1岁1.02 [95% 置信区间 1.01-1.02; I2=64%; 中等确定性]），黑人种族（1.23 [1.21-1.25]; I2=0%; 中等确定性），肝硬化（1.85 [1.64-2.08]; I2=0%; 高确定性），恶性肿瘤（1.43 [1.09-1.88]; I2=91%; 高确定性），以及Charlson合并症指数增加（每增加1分1.22 [1.19-1.25]; I2=0%; 高确定性）。

Presentation factors associated with increased mortality included acute kidney injury (1·88 [1·32-2·68]; I2 =86%; high certainty) and higher severity-of-illness scores, including Acute Physiology and Chronic Health Evaluation II score (1·10 per point increase [1·08-1·12]; I2 =60%; high certainty), Simplified Acute Physiology Score II (1·08 per point increase [1·06-1·09]; I2 =0%; high certainty), and Sequential Organ Failure Assessment (1·21 per point increase [1·15-1·28]; I2 =66%; high certainty).

与死亡率增加相关的表现因素包括急性肾损伤（1·88 [1·32-2·68]; I2 =86%; 高确定性）和更高的疾病严重程度评分，包括急性生理学和慢性健康评估II评分（每增加1分，1·10 [1·08-1·12]; I2 =60%; 高确定性）、简化急性生理学评分II（每增加1分，1·08 [1·06-1·09]; I2 =0%; 高确定性）和序贯器官衰竭评估（每增加1分，1·21 [1·15-1·28]; I2 =66%; 高确定性）。

Treatment and biochemical factors associated with increased mortality included invasive mechanical ventilation (2·12 [1·00-4·51]; I2 =86%; moderate certainty), norepinephrine use (3·60 [2·73-4·74]; I2 =0%; high certainty), and elevated serum lactate (1·13 per 1 mmol/L [1·01-1·26]; I2 =72%; high certainty).

与死亡率增加相关的治疗和生化因素包括侵入性机械通气（2·12 [1·00-4·51]; I2 =86%; 中等确定性）、去甲肾上腺素使用（3·60 [2·73-4·74]; I2 =0%; 高确定性）和血清乳酸升高（每增加1 mmol/L，1·13 [1·01-1·26]; I2 =72%; 高确定性）。

interpretation

This systematic reviewand meta-analysisidentified prognostic factors associated with early mortality in septic shock.

这项系统评价和荟萃分析确定了与脓毒性休克早期死亡相关的预后因素。

The identification of these prognostic factors could aid in clinical risk application, goals of care discussions, and identifying the subset of patients at highest and lowest risk of early mortality for patients with septic shock.

确定这些预后因素有助于临床风险评估、护理目标讨论，并识别出脓毒性休克患者中早期死亡风险最高和最低的患者亚组。

funding

None.

无。