OBJECTIVES : To estimate overall clinical and economic burden of distributive shock (DS) in United States (US) ICUs, which usually occurs in patients with septic shock.

METHODS : To estimate clinical and economic burden of DS treated in US ICUs, we identified all hospital admissions in the 2014 National Inpatient Sample (NIS) of persons (aged ≥18 years) with diagnoses of severe sepsis (ICD-9-CM 995.92) or septic shock (785.52), or diagnoses of organ dysfunction plus infection. We adjusted this count using an estimate of proportion of severe sepsis or septic shock cases with DS, which we estimated using data from the Medical Information Mart for Intensive Care (MIMIC-III); patients with DS in MIMIC-III were identified based on receipt of vasopressors for ≥6hrs and no evidence of shock of non-distributive etiology. We further adjusted this count for patients with severe sepsis not admitted to ICU. Mortality was estimated based on DS patients in MIMIC-III who died within 28 days of ICU admission. Costs of hospital admission were estimated using total charges for patients with severe sepsis or septic shock in NIS, which we converted to costs using hospital-specific Medicare cost-to-charge ratios. Finally, we increased the resulting estimate by 10% to account for physicians’ fees, for which data are not available in the NIS, based on a published estimate.

RESULTS : We estimate that 707,295 patients were admitted to ICU with DS in 2014, of whom 264,528 were projected to have died within 28 days. The estimated total economic cost of DS in the US in 2014 was $23.99 billion, assuming an average cost per hospital stay of $33,991.

CONCLUSIONS : DS, which occurs most frequently in patients with septic shock, was associated with almost 700,000 ICU admissions in the US in 2014, and more than 250,000 deaths; its resulting total direct economic burden approached $24 billion.