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Sepsis

Research Snapshot Theater: Sepsis/Shock, Adult I

(1635) Incidence of Endotoxic Septic Shock in the US and Canada

Tuesday, February 25, 2025
11:15am – 12:15pm Eastern Time
Location: Connections Central - RST 08

    First Author(s)

  • Laurence W. Busse, MBA, FCCM

    Emory Johns Creek Hospital
    Johns Creek, Georgia, United States

    • Co-Author(s)

  • NM

    Nikhil Meena, MD, FCCP

    Professor
    University of Arkansas for Medical Sciences, United States

  • Mark A. Tidswell, MD

    Baystate Medical Center
    Springfield, Massachusetts, USA

  • JK

    John A. Kellum, MD

    Chief Medical Officer, Spectral Medical Inc.; and Professor of Medicine
    The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pennsylvania, United States

Introduction: A post-hoc analysis of the EUPHRATES trial (PMID:30470853) indicated a benefit with polymyxin-B hemoadsorption for a subgroup of septic shock patients with endotoxic septic shock (ESS), defined by high endotoxin activity and multiple organ failure. The ongoing Tigris trial (NCT03901807) is enrolling patients meeting these criteria. However, the incidence of ESS in the population is unknown since endotoxin measurement is not routine. We sought to estimate the incidence of ESS in the US and Canada.

Methods: We analyzed screening logs from EUPHRATES (55 sites) from June 2012 to June 2016. A total of 17,575 patients with septic shock were screened for endotoxic septic shock (ESS) defined by requirement for high-dose (0.05mg/kg/min norepinephrine or equivalent), persistent (>2hours) vasopressors, multiple organ dysfunction scores (MODS) >9 and endotoxin activity >0.6 measured using the Endotoxin Activity Assay (EAA). Based on prior literature we estimated the incidence of septic shock and calculated the incidence of ESS from the proportion of septic shock patients meeting ESS criteria.

Results: After excluding patients receiving low-dose or short-term vasopressors (19.9%) or with baseline MODS 9 (24.9%), 9,707 (55.2%) were determined to have high severity septic shock. We tested 339 of these patients and 229 (67.6%) had EAA levels >0.6 indicating high endotoxin activity. From this proportion we estimated that 6,562 of high severity septic shock patents had ESS or 37.3% of all patients screened with septic shock. Next, we used an estimate of 450,443 patients per year from Paoli et al. (PMID:30048332) based on billing data as a low-end estimate of septic shock. A recent meta-analysis (PMID:31151462) found that 7% of ICU admissions met Sepsis-3 criteria for septic shock which would yield a high-end estimate for septic shock of 972,733 patients per year based on 2016 US population (327.2 M) and published ICU utilization rates. Using these figures, we estimate the incidence of ESS to be between 51.3 and 110.9 per 100,000 population per year.

Conclusions: Based on these incidence rates and 2024 populations, approximately 175,564 – 379,130 patients in the US and 15,933 – 34,407 in Canada develop Endotoxic Septic Shock (ESS) annually.