Meiping Wang1,2, Li Jiang3, Bo Zhu2, Wen Li2, Bin Du4, Yan Kang5, Li Weng4, Tiehe Qin6, Xiaochun Ma7, Duming Zhu8, Yushan Wang9, Qingyuan Zhan10, Meili Duan11, Wenxiong Li12, Bing Sun13, Xiangyuan Cao14, Yuhang Ai15, Tong Li16, Xi Zhu17, Jianguo Jia18, Jianxin Zhou19, Yan He1, Xiuming Xi2. 1. Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China. 2. Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China. 3. Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. 4. Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China. 5. Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China. 6. Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong, China. 7. Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China. 8. Surgical Intensive Care Unit, Department of Anaesthesiology, ZhongShan Hospital, FuDan University, Shanghai, China. 9. Intensive Care Unit, The First Hospital of Jilin University, Changchun, China. 10. Department of Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China. 11. Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China. 12. Surgical Intensive Care Unit, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. 13. Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. 14. Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Ningxia, China. 15. Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China. 16. Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China. 17. Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China. 18. Surgical Intensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China. 19. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Abstract
Background: Sepsis is a main cause of morbidity and mortality in critically ill patients. The epidemiology of sepsis in high-income countries is well-known, but information on sepsis in middle- or low-income countries is still deficient, especially in China. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically ill patients in tertiary hospitals in China. Methods: A multicenter prospective observational cohort study was performed with consecutively collected data from adults who stayed in any intensive care unit (ICU) for at least 24 h; data were collected from 1 January 2014 to 31 August 2015, and patients were followed until death or discharge from the hospital. Results: A total of 4,910 patients were enrolled in the study. Of these, 2,086 (42.5%) presented with sepsis or septic shock on admission to the ICU or within the first 48 h after admission to the ICU. ICU mortality was higher in patients with sepsis (13.1%) and septic shock (39.0%) and varied according to geographical region. Acinetobacter, Pseudomonas, and Staphylococcus infections were associated with increased ICU mortality. In addition, age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, pre-existing cardiovascular diseases, malignant tumors, renal replacement therapy (RRT), and septic shock were independent risk factors for mortality in patients with sepsis. The prompt administration of antibiotics (OR 0.65, 95% CI 0.46-0.92) and 30 mL/kg of initial fluid resuscitation during the first 3 h (OR 0.43, 95% CI 0.30-0.63) improved the outcome in patients with septic shock. Conclusions: Sepsis was common and was associated with a high mortality rate in critically ill patients in tertiary hospitals in China. The prompt administration of antibiotics and 30 mL/kg fluid resuscitation decreased the risk of mortality.
Background: Sepsis is a main cause of morbidity and mortality in critically illpatients. The epidemiology of sepsis in high-income countries is well-known, but information on sepsis in middle- or low-income countries is still deficient, especially in China. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically illpatients in tertiary hospitals in China. Methods: A multicenter prospective observational cohort study was performed with consecutively collected data from adults who stayed in any intensive care unit (ICU) for at least 24 h; data were collected from 1 January 2014 to 31 August 2015, and patients were followed until death or discharge from the hospital. Results: A total of 4,910 patients were enrolled in the study. Of these, 2,086 (42.5%) presented with sepsis or septic shock on admission to the ICU or within the first 48 h after admission to the ICU. ICU mortality was higher in patients with sepsis (13.1%) and septic shock (39.0%) and varied according to geographical region. Acinetobacter, Pseudomonas, and Staphylococcus infections were associated with increased ICU mortality. In addition, age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, pre-existing cardiovascular diseases, malignant tumors, renal replacement therapy (RRT), and septic shock were independent risk factors for mortality in patients with sepsis. The prompt administration of antibiotics (OR 0.65, 95% CI 0.46-0.92) and 30 mL/kg of initial fluid resuscitation during the first 3 h (OR 0.43, 95% CI 0.30-0.63) improved the outcome in patients with septic shock. Conclusions: Sepsis was common and was associated with a high mortality rate in critically illpatients in tertiary hospitals in China. The prompt administration of antibiotics and 30 mL/kg fluid resuscitation decreased the risk of mortality.
Authors: Marek Protus; Eva Uchytilova; Veronika Indrova; Jan Lelito; Ondrej Viklicky; Petra Hruba; Eva Kieslichova Journal: Front Med (Lausanne) Date: 2022-07-29