Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis

Abstract

Background Septic shock is the most severe form of sepsis, in which profound underlying abnormalities in circulatory and cellular/metabolic parameters lead to substantially increased mortality. A clear understanding and up-to-date assessment of the burden and epidemiology of septic shock are needed to help guide resource allocation and thus ultimately improve patient care. The aim of this systematic review and meta-analysis was therefore to provide a recent evaluation of the frequency of septic shock in intensive care units (ICUs) and associated ICU and hospital mortality. Methods We searched MEDLINE, Embase, and the Cochrane Library from 1 January 2005 to 20 February 2018 for observational studies that reported on the frequency and mortality of septic shock. Four reviewers independently selected studies and extracted data. Disagreements were resolved via consensus. Random effects meta-analyses were performed to estimate pooled frequency of septic shock diagnosed at admission and during the ICU stay and to estimate septic shock mortality in the ICU, hospital, and at 28 or 30 days. Results The literature search identified 6291 records of which 71 articles met the inclusion criteria. The frequency of septic shock was estimated at 10.4% (95% CI 5.9 to 16.1%) in studies reporting values for patients diagnosed at ICU admission and at 8.3% (95% CI 6.1 to 10.7%) in studies reporting values for patients diagnosed at any time during the ICU stay. ICU mortality was 37.3% (95% CI 31.5 to 43.5%), hospital mortality 39.0% (95% CI 34.4 to 43.9%), and 28-/30-day mortality 36.7% (95% CI 32.8 to 40.8%). Significant between-study heterogeneity was observed. Conclusions Our literature review reaffirms the continued common occurrence of septic shock and estimates a high mortality of around 38%. The high level of heterogeneity observed in this review may be driven by variability in defining and applying the diagnostic criteria, as well as differences in treatment and care across settings and countries. Electronic supplementary material The online version of this article (10.1186/s13054-019-2478-6) contains supplementary material, which is available to authorized users.

Predictive performance of PiCCO system and blood gas parameters for early prognosis of patients with sepsis

“…Although the absolute mortality has decreased from 35.0% to 18.4% in patients with severe sepsis in the areas of Australia and New Zealand during the last decades [7], one recent systematic review revealed the ICU mortality of sepsis in Europe and North America remains 37.3%, where the morbidity was estimated at 10.4% [8]. It is similar to these studies that the 28-day mortality was 42.9% in our study.…”

Morbidity and mortality in critically ill patients with invasive Group A streptococcus infection: an observational study

“…Sepsis and the more severe form, septic shock, are devastating conditions with high mortality and morbidity caused by a systemic infection leading to organ dysfunction (1,2). A recent extensive systemic review of observational studies from North America and Europe showed that 10% of patients admitted to intensive care units (ICU) were diagnosed with septic shock, with an ICU mortality of 38% (3). Gramnegative bacteria are the most common group of sepsis-causing organism (62%), but the incidence of gram-positive bacteria has increased in frequency over time (4).…”

Morbidity and mortality in critically ill patients with invasive Group A streptococcus infection: an observational study

“…Background 3 Sepsis and the more severe form, septic shock, are devastating conditions with high mortality and morbidity caused by a systemic infection leading to organ dysfunction (1,2). A recent extensive systemic review of observational studies from North America and Europe showed that 10% of patients admitted to intensive care units (ICU) were diagnosed with septic shock, with an ICU mortality of 38% (3). Gram-negative bacteria are the most common group of sepsis-causing organism (62%), but the incidence of gram-positive bacteria has increased in frequency over time (4).…”