Rubén Herrán-Monge1, Arturo Muriel-Bombín1, Marta M García-García1, Pedro A Merino-García1, Miguel Martínez-Barrios2, David Andaluz3, Juan Carlos Ballesteros4, Ana María Domínguez-Berrot5, Susana Moradillo-Gonzalez6, Santiago Macías7, Braulio Álvarez-Martínez8, M José Fernández-Calavia9, Concepción Tarancón10, Jesús Villar11,12, Jesús Blanco1,11. 1. 1 Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain. 2. 2 Intensive Care Unit, Hospital Universitario de Burgos, Burgos, Spain. 3. 3 Intensive Care Unit, Hospital Clínico Universitario, Valladolid, Spain. 4. 4 Intensive Care Unit, Complejo Hospitalario de Salamanca, Salamanca, Spain. 5. 5 Intensive Care Unit, Complejo Hospitalario de León, León, Spain. 6. 6 Intensive Care Unit, Hospital Río Carrión, Palencia, Spain. 7. 7 Intensive Care Unit, Hospital General de Segovia, Segovia, Spain. 8. 8 Intensive Care Unit, Hospital El Bierzo, Ponferrada, León, Spain. 9. 9 Intensive Care Unit, Complejo Hospitalario de Soria, Soria, Spain. 10. 10 Intensive Care Unit, Hospital Virgen de la Concha, Zamora, Spain. 11. 11 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 12. 12 Multidisciplinary Organ Dysfunction Evaluation Research Network (MODERN), Hospital Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain.
Abstract
PURPOSE: To determine the epidemiology and outcome of severe sepsis and septic shock after 9 years of the implementation of the Surviving Sepsis Campaign (SSC) and to build a mortality prediction model. METHODS: This is a prospective, multicenter, observational study performed during a 5-month period in 2011 in a network of 11 intensive care units (ICUs). We compared our findings with those obtained in the same ICUs in a study conducted in 2002. RESULTS: The current cohort included 262 episodes of severe sepsis and/or septic shock, and the 2002 cohort included 324. The prevalence was 14% (95% confidence interval: 12.5-15.7) with no differences to 2002. The population-based incidence was 31 cases/100 000 inhabitants/year. Patients in 2011 had a significantly lower Acute Physiology and Chronic Health Evaluation II (APACHE II; 21.9 ± 6.6 vs 25.5 ± 7.07), Logistic Organ Dysfunction Score (5.6 ± 3.2 vs 6.3 ± 3.6), and Sequential Organ Failure Assessment (SOFA) scores on day 1 (8 ± 3.5 vs 9.6 ± 3.7; P < .01). The main source of infection was intraabdominal (32.5%) although microbiologic isolation was possible in 56.7% of cases. The 2011 cohort had a marked reduction in 48-hour (7% vs 14.8%), ICU (27.2% vs 48.2%), and in-hospital (36.7% vs 54.3%) mortalities. Most relevant factors associated with death were APACHE II score, age, previous immunosuppression and liver insufficiency, alcoholism, nosocomial infection, and Delta SOFA score. CONCLUSION: Although the incidence of sepsis/septic shock remained unchanged during a 10-year period, the implementation of the SSC guidelines resulted in a marked decrease in the overall mortality. The lower severity of patients on ICU admission and the reduced early mortality suggest an improvement in early diagnosis, better initial management, and earlier antibiotic treatment.
PURPOSE: To determine the epidemiology and outcome of severe sepsis and septic shock after 9 years of the implementation of the Surviving Sepsis Campaign (SSC) and to build a mortality prediction model. METHODS: This is a prospective, multicenter, observational study performed during a 5-month period in 2011 in a network of 11 intensive care units (ICUs). We compared our findings with those obtained in the same ICUs in a study conducted in 2002. RESULTS: The current cohort included 262 episodes of severe sepsis and/or septic shock, and the 2002 cohort included 324. The prevalence was 14% (95% confidence interval: 12.5-15.7) with no differences to 2002. The population-based incidence was 31 cases/100 000 inhabitants/year. Patients in 2011 had a significantly lower Acute Physiology and Chronic Health Evaluation II (APACHE II; 21.9 ± 6.6 vs 25.5 ± 7.07), Logistic Organ Dysfunction Score (5.6 ± 3.2 vs 6.3 ± 3.6), and Sequential Organ Failure Assessment (SOFA) scores on day 1 (8 ± 3.5 vs 9.6 ± 3.7; P < .01). The main source of infection was intraabdominal (32.5%) although microbiologic isolation was possible in 56.7% of cases. The 2011 cohort had a marked reduction in 48-hour (7% vs 14.8%), ICU (27.2% vs 48.2%), and in-hospital (36.7% vs 54.3%) mortalities. Most relevant factors associated with death were APACHE II score, age, previous immunosuppression and liver insufficiency, alcoholism, nosocomial infection, and Delta SOFA score. CONCLUSION: Although the incidence of sepsis/septic shock remained unchanged during a 10-year period, the implementation of the SSC guidelines resulted in a marked decrease in the overall mortality. The lower severity of patients on ICU admission and the reduced early mortality suggest an improvement in early diagnosis, better initial management, and earlier antibiotic treatment.
Entities:
Keywords:
Surviving Sepsis Campaign; epidemiology; mortality; organ failure; septic shock; severe sepsis
Authors: Minakshi Rana; Andrea La Bella; Rivka Lederman; Bruce T Volpe; Barbara Sherry; Betty Diamond Journal: J Clin Invest Date: 2021-06-15 Impact factor: 14.808
Authors: Zhongheng Zhang; Lin Chen; Ping Xu; Qing Wang; Jianjun Zhang; Kun Chen; Casey M Clements; Leo Anthony Celi; Vitaly Herasevich; Yucai Hong Journal: NPJ Digit Med Date: 2022-07-19
Authors: Megan E Foeller; Lillian Sie; Timothy M Foeller; Anna I Girsen; Suzan L Carmichael; Deirdre J Lyell; Henry C Lee; Ronald S Gibbs Journal: Am J Perinatol Date: 2019-09-17 Impact factor: 1.862
Authors: C Fleischmann-Struzek; L Mellhammar; N Rose; A Cassini; K E Rudd; P Schlattmann; B Allegranzi; K Reinhart Journal: Intensive Care Med Date: 2020-06-22 Impact factor: 17.440
Authors: Juan José Martínez-García; Helios Martínez-Banaclocha; Diego Angosto-Bazarra; Carlos de Torre-Minguela; Alberto Baroja-Mazo; Cristina Alarcón-Vila; Laura Martínez-Alarcón; Joaquín Amores-Iniesta; Fátima Martín-Sánchez; Giovanni A Ercole; Carlos M Martínez; Ada González-Lisorge; José Fernández-Pacheco; Piedad Martínez-Gil; Sahil Adriouch; Friedrich Koch-Nolte; Juan Luján; Francisco Acosta-Villegas; Pascual Parrilla; Carlos García-Palenciano; Pablo Pelegrin Journal: Nat Commun Date: 2019-06-20 Impact factor: 14.919
Authors: Craig S Jabaley; Robert F Groff; Theresa J Barnes; Mark E Caridi-Scheible; James M Blum; Vikas N O'Reilly-Shah Journal: PLoS One Date: 2019-08-22 Impact factor: 3.240
Authors: Tushar Gupta; Michael A Puskarich; Elizabeth DeVos; Adnan Javed; Carmen Smotherman; Sarah A Sterling; Henry E Wang; Frederick A Moore; Alan E Jones; Faheem W Guirgis Journal: J Intensive Care Med Date: 2018-08-30 Impact factor: 3.510