Benchmarking the Incidence and Mortality of Severe Sepsis in the United States*

Gaieski, David F.; Edwards, Jeremy; Kallan, Michael J.; Carr, Brendan G.

doi:10.1097/ccm.0b013e31827c09f8

Cited by 1,143 publications

(898 citation statements)

References 31 publications

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“…Meaningful comparisons of figures across studies from different countries are difficult because of widely varying study designs and definitions of sepsis. The use of less restrictive definitions than those mandated by the German coding guidelines elevates the apparent incidence of sepsis and, in most cases, lowers its apparent mortality (20). The incidence of sepsis found in the present study, adjusted to the structure of the United States population (as per the 2000 census), is 236/100 000 and thus lower than the American figure of 377/100 000 (3) (eTable 2).…”

Section: Discussioncontrasting

confidence: 51%

Hospital Incidence and Mortality Rates of Sepsis: An Analysis of Hospital Episode (DRG) Statistics in Germany From 2007 to 2013

Fleischmann¹,

Thomas-Rueddel²,

Hartmann³

et al. 2016

Deutsches Ärzteblatt International

178

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Section: Discussioncontrasting

confidence: 51%

Hospital Incidence and Mortality Rates of Sepsis: An Analysis of Hospital Episode (DRG) Statistics in Germany From 2007 to 2013

Fleischmann¹,

Thomas-Rueddel²,

Hartmann³

et al. 2016

Deutsches Ärzteblatt International

178

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“…2 Despite this, the complex pathophysiological response to infection remains to be fully elucidated, and a gold-standard test for serious infection (or colloquially, 'sepsis') does not currently exist. In the absence of a gold-standard test, several groups have attempted to provide clinical criteria for the identification of infected patients at risk of significant mortality.…”

Section: Introductionmentioning

confidence: 99%

Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction

Williams

Greenslade

McKenzie

et al. 2017

CHEST

248

148

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M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTAbbreviations: CI = confidence interval, CNS = central nervous system, Cr = creatinine, CVS = cardiovascular system, ED = emergency department, FiO2 = fraction inspired oxygen, GCS = Glascow coma score, GIT = gastrointestinal system, HAEM = haematological system, HR = hazard ratio, ICU = intensive care unit, IQR = inter-quartile range, NA = noradrenaline, OR = odds ratio, PaO2 = arterial oxygen partial pressure (mmHg), RA = room air, RESP = respiratory system, RR = relative risk, SBP = systolic blood pressure, SD = standard deviation, SIRS = systemic inflammatory response syndrome, SOFA = sequential organ function assessment, SpO2 = oximetry saturation, UO = urine output. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT ABSTRACTObjective: A proposed revision of sepsis definitions has abandoned SIRS, defined organ dysfunction as an increase in total SOFA score of ≥2, and conceived "qSOFA" as a bedside indicator of organ dysfunction. We aimed to (1) determine the prognostic impact of SIRS, (2) compare diagnostic accuracy of SIRS and qSOFA for organ dysfunction, and (3) compare standard (Sepsis-2) and revised (Sepsis-3) definitions for organ dysfunction in emergency department patients with infection.Methods: Consecutive ED patients admitted with presumed infection were prospectively enrolled over three years. Observational data were collected sufficient to calculate SIRS, qSOFA, SOFA, comorbidity and mortality.Results: 8871 patients were enrolled, 4176 (47.1%) with SIRS. SIRS was associated with increased risk of organ dysfunction (RR 3.5), and mortality in patients without organ dysfunction (OR 3.2). SIRS and qSOFA showed similar discrimination for organ dysfunction (AUROC 0.72 vs 0.73). qSOFA was specific but poorly sensitive for organ dysfunction (96.1%, 29.7% respectively). Mortality for patients with organ dysfunction was similar for Sepsis-2 and Sepsis-3 (12.5%, 11.4%) although 29% of patients with Sepsis-3 organ dysfunction did not meet Sepsis-2 criteria. Increasing number of Sepsis-2 organ dysfunctions was associated with greater mortality.Conclusions: SIRS was associated with organ dysfunction and mortality, and abandoning the concept appears premature. Although qSOFA≥2 showed high specificity, poor sensitivity may limit utility as a bedside screen. Although mortality for organ dysfunction was comparable between Sepsis-2 and Sepsis-3, more prognostic and clinical information is conveyed using Sepsis-2 regarding number of organ dysfunctions. The SOFA score may require recalibration.

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“…We evaluated patients' "present on admission" International Classification of Disease version 9 diagnosis codes to quantify associated organ dysfunction based on criteria detailed in prior studies (4,25).…”

Section: Hospital Datamentioning

confidence: 99%

Fluid Volume, Lactate Values, and Mortality in Sepsis Patients with Intermediate Lactate Values

et al. 2013

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Rationale: Patients with severe sepsis without shock or tissue hypoperfusion face substantial mortality; however, treatment guidelines are lacking. Hospital and 30-day mortality were 8.2 and 13.3%, respectively, for patients with lactate clearance; they were 18.7 and 24.7%, respectively, for those without lactate clearance. Each 10% increase in repeat lactate values was associated with a 9.4% (95% confidence interval [CI] = 7.8-11.1%) increase in the odds of hospital death. Within 4 hours, patients received 32 (618) ml/kg of fluid. Each 7.5 ml/kg increase was associated with a 1.3% (95% CI = 0.6-2.1%) decrease in repeat lactate. Across an unrestricted range, increased fluid was not associated with improved mortality. However, when limited to less than 45 ml/kg, additional fluid was associated with a trend toward improved survival (odds ratio = 0.92; 95% CI = 0.82-1.03) that was statistically significant among patients with highly concordant fluid records.Conclusions: Early fluid administration, below 45 ml/kg, was associated with modest improvements in lactate clearance and potential improvements in mortality. Further study is needed to define treatment strategies in this prevalent and morbid group of patients with sepsis.

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Benchmarking the Incidence and Mortality of Severe Sepsis in the United States*

Cited by 1,143 publications

References 31 publications

Hospital Incidence and Mortality Rates of Sepsis: An Analysis of Hospital Episode (DRG) Statistics in Germany From 2007 to 2013

Hospital Incidence and Mortality Rates of Sepsis: An Analysis of Hospital Episode (DRG) Statistics in Germany From 2007 to 2013

Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction

Fluid Volume, Lactate Values, and Mortality in Sepsis Patients with Intermediate Lactate Values

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