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• W2947228081 abstract "<h3>Background:</h3> Cholecystitis-associated septic shock carries a significant mortality. Our aim was to determine whether timing of source control affects survival in cholecystitis patients with septic shock. <h3>Methods:</h3> We conducted a nested cohort study of all patients with cholecystitis-associated septic shock from an international, multicentre database (1996–2015). Multivariable logistic regression was performed to determine associations between clinical factors and in-hospital mortality. The results were used to inform a classification and regression tree (CART) analysis that modelled the association between disease severity (APACHE II), time to source control and survival. <h3>Results:</h3> Among 196 patients with cholecystitis-associated septic shock, overall mortality was 37%. Compared with nonsurvivors (<i>n</i> = 72), survivors (<i>n</i> = 124) had lower mean admission APACHE II scores (21 v. 27, <i>p</i> < 0.001) and lower median admission serum lactate (2.4 v. 6.8 μmol/L, <i>p</i> < 0.001). Survivors were more likely to receive appropriate antimicrobial therapy earlier (median 2.8 v. 6.1 h from shock, <i>p</i> = 0.012). Survivors were also more likely to undergo successful source control earlier (median 9.8 v. 24.7 h from shock, <i>p</i> < 0.001). Adjusting for covariates, APACHE II (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.06–1.21 per increment) and delayed source control > 16 h (OR 4.45, 95% CI 1.88–10.70) were independently associated with increased mortality (all <i>p</i> < 0.001). The CART analysis showed that patients with APACHE II scores of 15–26 benefitted most from source control within 16 h (<i>p</i> < 0.0001). <h3>Conclusion:</h3> In patients with cholecystitis-associated septic shock, admission APACHE II score and delay in source control (cholecystectomy or percutaneous cholecystostomy drainage) significantly affected hospital outcomes." @default.
• W2947228081 created "2019-06-07" @default.
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• W2947228081 date "2019-06-01" @default.
• W2947228081 modified "2023-09-24" @default.
• W2947228081 title "The impact of delayed source control and antimicrobial therapy in 196 patients with cholecystitis-associated septic shock: a cohort analysis" @default.
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• W2947228081 doi "https://doi.org/10.1503/cjs.009418" @default.
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