Has the mortality of septic shock changed with time?

Objectives: To determine whether a systematic review of the literature coul d identify changes in the mortality of septic shock over time. Data Sources: A review of all relevant papers from 1958 to August 1997, ide ntified through a MEDLINE search and from the bibliographies of articles id entified. Data Synthesis: The search identified 131 studies (99 prospective and 32 re trospective) involving a total of 10,694 patients, The patients' mean age w as 57 yrs with no change over time, The overall mortality rate in the 131 s tudies was 49.7%. There was an overall significant trend of decreased morta lity over the period studied (r(2) = .49, p < .05). The mortality rate in t hose patients with bacteremia as an entry criterion was greater than that r ate in patients whose entry criterion was sepsis without definite bacteremi a (52.1% vs. 49.1%; chi(2) = 6.1 and p < .05). The site of infection altered noticeably over the years, Chest-related infe ctions increased over time, with Gram-negative infections becoming proporti onately less common, If all other organisms and mixed infections are includ ed with the Gram-positives, the result is more dramatic, with these organis ms being causative in just 10% of infections between 1958 and 1979 but in 3 1% of infections between 1980 and 1997. Conclusions: The present review showed a slight reduction in mortality from septic shock over the years, although this result should be approached wit h caution. The heterogeneity of the ar tides and absence of a severity scor e for most of the studies limited our analysis. Furthermore, there was an i ncreasing prevalence of Gram positive causative organisms, and a change of the predominant origin of sepsis from the abdomen to the chest.