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The optimal cut-offs for prediction of complications and mortality used in this study are in accordance with previous studies, with the exception of the cut-off for PRISM-III of 76.5. Using this as a cut-off, the sensitivity is similar to what Martin *et al*. found, but the specificity is higher. On the other hand, the cut-off for the degree of organ system failure that has been used in previous studies, e.g. Murray *et al*., 78.5 \[[@pone.0169220.ref016]\] or El-Serag *et al*., 83 \[[@pone.0169220.ref028]\] is lower than this value. This is likely related to the selection of all patients with sepsis, not only those with organ failure and a higher degree of organ failure. It can be questioned whether this is a reasonable cut-off for identifying patients who have organ failure, since the patients with septic shock and a high degree of organ failure can have a high mortality in the absence of organ failure.
In our study, nearly half of the patients with septic shock had an unknown source of infection. This is in accordance with previous studies \[[@pone.0169220.ref013],[@pone.0169220.ref015],[@pone.0169220.ref029]\]. It could be argued that this was not a severe infection, since the source of infection was unknown. However, based on the Swedish national guidelines \[[@pone.0169220.ref030]\], the management of patients with a septic shock, or a shock caused by severe infection, where the source of infection is unknown, was the same as if the source of infection was clinically identified. Further studies are needed to investigate the time when the source of infection is identified.
The aim of this study was to examine the predictors of mortality and survival in patients with a septic shock, and to compare the performance of the Acute Phys