Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study

Abstract

IntroductionSepsis is a leading cause of admission to non-cardiological intensive care units (ICUs) and the second leading cause of death among ICU patients. We present the first extensive dataset on the epidemiology of severe sepsis treated in ICUs in Spain.MethodsWe conducted a prospective, observational, multicentre cohort study, carried out over two 3-month periods in 2002. Our aims were to determine the incidence of severe sepsis among adults in ICUs in a specific area in Spain, to determine the early (48 h) ICU and hospital mortality rates, as well as factors associated with the risk of death.ResultsA total of 4,317 patients were admitted and 2,619 patients were eligible for the study; 311 (11.9%) of these presented at least 1 episode of severe sepsis, and 324 (12.4%) episodes of severe sepsis were recorded. The estimated accumulated incidence for the population was 25 cases of severe sepsis attended in ICUs per 100,000 inhabitants per year. The mean logistic organ dysfunction system (LODS) upon admission was 6.3; the mean sepsis-related organ failure assessment (SOFA) score on the first day was 9.6. Two or more organ failures were present at diagnosis in 78.1% of the patients. A microbiological diagnosis of the infection was reached in 209 episodes of sepsis (64.5%) and the most common clinical diagnosis was pneumonia (42.8%). A total of 169 patients (54.3%) died in hospital, 150 (48.2%) of these in the ICU. The mortality in the first 48 h was 14.8%. Factors associated with early death were haematological failure and liver failure at diagnosis, acquisition of the infection prior to ICU admission, and total LODS score on admission. Factors associated with death in the hospital were age, chronic alcohol abuse, increased McCabe score, higher LODS on admission, ΔSOFA 3-1 (defined as the difference in the total SOFA scores on day 3 and on day 1), and the difference of the area under the curve of the SOFA score throughout the first 15 days.ConclusionsWe found a high incidence of severe sepsis attended in the ICU and high ICU and hospital mortality rates. The high prevalence of multiple organ failure at diagnosis and the high mortality in the first 48 h suggests delays in diagnosis, in initial resuscitation, and/or in initiating appropriate antibiotic treatment.

Are there new approaches for diagnosis, therapy guidance and outcome prediction of sepsis?

“…During severe sepsis or septic shock, development of organ dysfunction dramatically increases morbidity and mortality [93] . During the acute phase of sepsis or septic shock, circulatory failure is discussed as the predominant cause of death [94,95] . However, underlying mechanisms leading to organ failure are not fully understood yet.…”

Cost-effectiveness of the Surviving Sepsis Campaign protocol for severe sepsis: a prospective nation-wide study in Spain

“…In Spain, an estimated 40,000 cases of severe sepsis and 12,000 sepsis-related deaths occur each year [4,5]. The Surviving Sepsis Campaign (SSC) protocol was developed as an international initiative to reduce mortality due to severe sepsis and is promoted by several critical care societies [6,7].…”

Septic cardiomyopathy : pathophysiology and prognosis

“…(20,21) Early reports using conventional echocardiography suggested that increased enddiastolic volume and reduced ejection fraction was associated with an improved prognosis and could be considered as an adaptive change. However a meta-analysis of 14 studies looking at studies of ventricular volumes and dysfunction published up to 2012 has shown that survivors had lower ejection fractions and that there is no significant differences in LVEF or RVEF or in RV dimensions between survivors and non-survivors from severe sepsis or septic shock.…”