Trial reportCritical care (London, England)2016
Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study.
Trial report in Critical care (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis.Critical care (London, England) · 2019Pooled it
- Risk factors associated with apyrexia during bacteraemia: a prospective multicenter cohort study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Platelet glycoprotein VI modulates leukocyte characteristics in sepsis-induced systemic inflammatory response in male mice.Physiological reports · 2026Article
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Early Antibiotic Therapy in Sepsis Without Shock: A Multimethod Study of Heterogeneous Treatment Effects in ICU Patients.Infectious diseases and therapy · 2026Article
- Data-driven spatial-temporal framework for exploring the heterogeneity and temporality of sepsis.Chinese medical journal · 2026Review
- Early initiated noradrenaline versus fluid therapy for hypotension and shock in the emergency department (VASOSHOCK): a protocol for a pragmatic, multi-center, superiority, randomized controlled trial.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Case Report: Iatrogenic intraperitoneal hematoma compresses the ureters leading to urogenic sepsis.Frontiers in medicine · 2025Article
- Sepsis mimics among presumed sepsis patients at intensive care admission: a retrospective observational study.Infection · 2024Observational
- Multiorgan Point-of-Care Ultrasound Assessment in Critically Ill Adults.Journal of intensive care medicine · 2024Article
- Concordance Between Initial Presumptive and Final Adjudicated Diagnoses of Infection Among Patients Meeting Sepsis-3 Criteria in the Emergency Department.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Antibiotic stewardship in the ICU: time to shift into overdrive.Annals of intensive care · 2023Review
- 2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department.Journal of clinical medicine · 2023Review
- Scoping review on diagnostic criteria and investigative approach in sepsis of unknown origin in critically ill patients.Journal of intensive care · 2022Article
- New, Useful Criteria for Assessing the Evidence of Infection in Sepsis Research.Critical care explorations · 2022Article
- Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.Intensive care medicine · 2021Article
- Independent Risk Factors for Sepsis-Associated Cardiac Arrest in Patients with Septic Shock.International journal of environmental research and public health · 2021Observational
- The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2021Article
- Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance.Frontiers in medicine · 2021Review
Corrections and comments
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic shock to those of others.
methodsWe conducted a pragmatic, prospective, multicenter observational cohort study in ten intensive care units (ICU) in France. We included all consecutive patients admitted to the ICU with suspected septic shock defined by clinical suspicion of infection leading to antibiotic prescription plus acute circulatory failure requiring vasopressor support.
resultsA total of 508 patients were admitted with suspected septic shock. Among them, 374 (74 %) had early-confirmed septic shock, while the 134 others (26 %) had no source of infection identified nor microbiological documentation retrieved 24 hours after shock onset. Among these, 37/134 (28 %) had late-confirmed septic shock diagnosed after 24 hours, 59/134 (44 %) had a condition mimicking septic (septic shock mimicker, mainly related to adverse drug reactions, acute mesenteric ischemia and malignancies) and 38/134 (28 %) had shock of unknown origin by the end of the ICU stay. There were no differences between patients with early-confirmed septic shock and the remainder in ICU mortality and the median duration of ICU stay, of tracheal intubation and of vasopressor support. The multivariable Cox model showed that the risk of day-60 mortality did not differ between patients with or without early-confirmed septic shock. A sensitivity analysis was performed in the subgroup (n = 369/508) of patients meeting the Sepsis-3 definition criteria and displayed consistent results.
conclusionsOne quarter of the patients admitted in the ICU with suspected septic shock had no infection identified 24 hours after its onset and almost half of them were eventually diagnosed with a septic shock mimicker. Outcome did not differ between patients with early-confirmed septic shock and other patients.
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