BACKGROUND: In the United States, over half of all deaths are attributed to five leading underlying causes of death (at the ICD-3 digit level). However, these underlying causes represent only 25% of the total medical information documented on death certificates. While previous studies have investigated associations between causes of death, none have specifically examined the mechanisms of interaction among these causes. This study aims to explore the role of contributory causes of death recorded in Part 2 of the death certificate in the lethal process. METHODS: Working with U.S. Multiple Cause of Death Microdata in 2019, we use causal pie models to model the synergy between multiple causes of death. RESULTS: The findings show how contributory causes in Part 2 affect the sequence of morbid events leading to death. Three broad categories of roles can be distinguished: (i) some contributory causes act as mediators in the chain of morbid events, (ii) others do not exhibit any interaction with the conditions listed in Part 1, and (iii) some might play a role in the development of underlying causes. CONCLUSION: Contributory causes listed in Part 2 play a crucial role in transitions to terminal morbid states. There is evidence that these are more than just conditions without a direct relationship to the underlying cause of death.

• Klíčová slova
• Causal pies, Contributory causes, Mediation, Multiple causes of death,
• MeSH
• lidé MeSH
• příčina smrti MeSH
• úmrtní listy * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Spojené státy americké epidemiologie   MeSH

Sepsis (and septic shock) is on of the most common causes of death worldwide. Bacteremia often, but not necessarily, occurs in septic patients, but the impact of true bacteremia on a patient's clinical characteristics and outcome remains unclear. The main aim of this study was to compare the characteristics and outcome of a well-defined cohort of 258 septic patients with and without bacteremia treated in the intensive care unit (ICU) of a tertiary center hospital in Prague, Czech Republic. As expected, more frequently, bacteremia was present in patients without previous antibiotic treatment. A higher proportion of bacteremia was observed in patients with infective endocarditis as well as catheter-related and soft tissue infections in contrast to respiratory sepsis. Multivariant analysis showed increased severity of clinical status and higher Charlson comorbidity index (CCI) as variables with significant influence on mortality. Bacteremia appears to be associated with higher mortality rates and length of ICU stay in comparison with nonbacteremic counterparts, but this difference did not reach statistical significance. The presence of bacteremia, apart from previous antibiotic treatment, may be related to the site of infection.

• Klíčová slova
• ICU, Sepsis-3, bacteremia, foci of infection, outcome, sepsis, septic shock,
• Publikační typ
• časopisecké články MeSH