N=84 / No septic shock
N= 157 / p-values*
Baseline characteristics
Age, year (median, IQR) / 64 (53-70) / 61 (50-71) / 0.32
Sex, Male n (%) / 47/84 (56) / 112/157 (71.3) / 0.08
Setting of acquisition
Community-acquired
Health-care-associated
Hospital-acquired / 8/84 (9.5)
6/84 (7.1)
70/84 (83.3) / 7/157 (4.5)
12/157 (7.6)
138/157 (87.9) / 0.27
0.9
0.50
Ward
ICU
Internal medicine
Surgical ward
Other / 63/84 (75)
11/84 (13.1)
9/84 (10.7)
1/84 (1.2) / 58/157 (36.9)
57/157 (36.3)
30/157 (19.1)
12/157 (7.6) / 0.001
0.001
0.23
0.13
Charlson score (median, IQR) / 4 (2-6) / 4 (3-6) / 0.50
SOFA score (median, IQR) / 7 (4 – 13) / 5 (3 – 7) / 0.17
Etiology of liver disease
Alchool
Viral (HBV and HCV)
Autoimmune
NAFLD
Criptogenetic / 33/84 (39.3)
34/84 (40.5)
6/84 (7.1)
5/84 (6)
6/84 (7.1) / 65/157 (41.4)
65/157 (41.4)
10/157 (6.4)
7/157 (4.4)
10/157 (6.4) / 0.84
0.92
0.87
0.75
0.87
MELD
<15
15-25
>25 / 9/84 (10.7)
41/84 (48.8)
34/84 (40.5) / 70/157 (44.6)
59/157 (37.6)
28/157 (17.8) / 0.001
0.23
0.001
Comorbidities
Hematologic malignancies / 1/84 (1.2) / 5/157 (3.2) / 0.5
HIV infection / 2/84 (2.4) / 9/157 (5.7) / 0.41
Solid tumor / 29/84 (34.5) / 41/157 (26.1) / 0.32
Dialytic renal failure / 30/84 (35.7) / 21/157 (13.4) / 0.001
COPD / 17/84 (20.2) / 25/157 (15.9) / 0.55
Diabetes / 19/84 (22.6) / 38/157 (24.2) / 0.85
Heart disease / 28/84 (33.3) / 43/157 (27.4) / 0.50
Renal failure (GFR<60 ml/min) / 45/84 (53.6) / 62/157 (39.5) / 0.13
Liver transplant recipient / 4/84 (4.8) / 15/157 (9.6) / 0.34
HCC / 16/84 (19) / 22/157 (14) / 0.49
Previous abdominal surgery / 47/84 (56) / 69/157 (44) / 0.22
Re-operation / 21/47 (44.7) / 26/69 (37.7) / 0.59
Anastomotic leakage / 7/47 (14.9) / 4/69 (5.8) / 0.34
Type of surgery
GI surgery
Liver transplant
Other / 35/47 (74.5)
3/47 (6.4)
9/47 (19.2) / 31/69 (44.9)
9/69 (13)
29/69 (42) / 0.02
0.55
0.05
Vascular devices / 48/84 (57.1) / 106/157 (67.5) / 0.26
Abdominal devices / 39/84 (46.4) / 49/157 (31.2) / 0.08
Parenteral nutrition / 53/84 (63.1) / 78/157 (49.7) / 0.15
Recent antimicrobial therapy / 73/84 (86.9) / 130/157 (82.8) / 0.55
Steroid treatment / 18/84 (21.4) / 26/157 (16.6) / 0.51
Immunosuppressants / 6/84 (7.1) / 25/157 (15.9) / 0.15
Candida colonization / 51/84 (60.7) / 62/157 (39.5) / 0.02
Type of abdominal candidiasis
Peritonitis
Biliary tract infection
Pancreatitis
Abdominal abscesses
Other / 25/30 (83.3)
1/30 (3.3)
0/30 (0)
1/30 (3.3)
3/30 (10) / 21/42 (50)
6/42 (14.3)
2/42 (4.8)
8/42 (19.1)
5/42 (11.9) / 0.03
0.42
0.79
0.23
>0.99
Clinical presentation
Acute on chronic liver failure / 59/84 (70.2) / 49/157 (31.2) / 0.001
Fever (T≥38°C) / 51/84 (60.7) / 95/157 (60.5) / 0.99
Recent GI bleeding (1 month) / 19/84 (22.6) / 26/157 (16.6) / 0.42
Ascites / 55/84 (65.5) / 100/157 (63.7) / 0.85
Encefalopathy / 38/84 (45.2) / 46/157 (29.3) / 0.05
Concomitant bacterial infection / 50/84 (59.5) / 72/157 (45.9) / 0.13
ICU admission after infection onset / 65/87 (74.7) / 41/157 (26.1) / 0.001
Candidemia / 54 (64.3) / 115 (73.3) / 0.28
Abdominal Candidiasis / 30 (35.7) / 42 (26.8) / 0.30
Laboratory findings
WBC (median value, IQR) / 12000 (8300 – 21800) / 8825 (5300 – 15312) / 0.05
PCR (median value, IQR) / 135 (50.2 – 212.3) / 57 (17 – 103) / 0.001
PCT (median value, IQR) / 2.05 (1.04 – 7.3) / 0.7 (0.34 – 2.32) / 0.05
BDG (median value, IQR) / 272 (146 – 489) / 479.5 (220.5 – 500) / 0.55
Candida species distribution
Candida specie
C. albicans
C. dubliniensis
C. glabrata
C. kruzei
C. parapsilosis
C. tropicalis
More than 1 Candida / 44/84 (52.4)
1/84 (1.2)
16/84 (19.1)
3/84 (3.6)
10/84 (11.9)
6/84 (7.1)
4/84 (4.8) / 87/157 (55.4)
0/157 (0)
19/157 (12.1)
3/157 (1.9)
24/147 (15.3)
8/157 (5.1)
16/157 (10.2) / 0.79
0.32
0.3
0.57
0.61
0.66
0.3
Fluconazole-S (n=240) / 70/84 (83.3) / 132/156 (84.6) / 0.87
Caspofungin-S (n=240) / 81/84 (96.4) / 152/156 (97.4) / 0.79
Voriconazole-S (n=240) / 78/84 (92.9) / 143/156 (91.7) / 0.84
Amphotericin B-S (n=222) / 80/82 (97.6) / 132/140 (94.3) / 0.42
Treatment and source control
Timing of adequate source control (n=114)
Within 24h
24-48h
48-72h
>72 / 31/41 (75.6)
8/41 (19.5)
1/41 (2.4)
1/41 (2.4) / 38/73 (52)
19/73 (26)
8/73 (11)
8/73 (11) / 0.05
0.57
0.26
0.26
Initial antifungal treatment
Amphotericin B
Azoles
Echinocandin
None / 14/84 (16.7)
21/84 (25)
40/84 (47.6)
9/84 (10.7) / 9/157 (5.7)
61/157 (38.9)
68/157 (43.3)
19/157 (12.1) / 0.04
0.12
0.66
0.84
Adequate antifungal treatment / 72/84 (85.7) / 130/157 (82.8) / 0.7
Timing of adequate antifungal treatment (n =188)
Within 24h
24-48h
48-72h
>72 / 50/70 (71.4)
11/70 (15.7)
5/70 (7.1)
4/70 (5.7) / 64/118 (54.2)
21/118 (17.8)
14/118 (11.9)
19/118 (16.1) / 0.08
0.83
0.48
0.13
Duration of antifungal treatment (days) (median, IQR) / 14 (5-25) / 14 (6-21) / 0.98
De-escalation to fluconazole (if susceptible strain) (n=186) / 9/73 (12.3) / 29/113 (25.6) / 0.12
Timing (days) of de-escalation to fluconazole
(median, IQR) / 10 (5.5-18.5) / 5 (2 – 7.5) / 0.13
Death within 30 days / 41/84 (48.8) / 44/157 (28) / 0.01
Table A supplemental. Differences between patients with septic shock compared with patients without septic shock.
Abbreviations: : HBV, hepatitis B virus; HCV, hepatitis C virus; GFR, glomerular filtration rate; GI, gastrointestinal; HCC, hepatocellular carcinoma; ICU, intensive care unit; IQR, interquartile range; MELD, Model for End-Stage Liver Disease; NAFDL, Non-alcoholic fatty liver disease; SOFA, Sequential Organ Failure Assessment score. °° Anastomotic leakage includes biliary, gastric, or intestinal leakage
* p-values adjusted using False Discovery Rate (FDR) method