Epidemiology and Changes in Mortality of Sepsis After the Implementation of Surviving Sepsis Campaign Guidelines
| Autor: | Ana M. Domínguez-Berrot, Arturo Muriel-Bombín, Jesús Blanco, M. José Fernández-Calavia, Pedro A. Merino-García, Santiago Macías, Miguel Martínez-Barrios, Rubén Herrán-Monge, Concepción Tarancón, Braulio Álvarez-Martínez, Susana Moradillo-Gonzalez, Marta M. García-García, Juan Carlos Ballesteros, Jesús Villar, David Andaluz |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Surviving Sepsis Campaign Critical Care Organ Dysfunction Scores Critical Care and Intensive Care Medicine Risk Assessment Sepsis 03 medical and health sciences 0302 clinical medicine Early Medical Intervention Epidemiology medicine Prevalence Humans Mortality prediction Hospital Mortality Intensive care medicine Severe sepsis APACHE Aged Septic shock business.industry Incidence Age Factors 030208 emergency & critical care medicine Middle Aged medicine.disease Quality Improvement Shock Septic 030228 respiratory system Spain Practice Guidelines as Topic Intraabdominal Infections Female business |
| Zdroj: | Journal of intensive care medicine. 34(9) |
| ISSN: | 1525-1489 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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