Research
Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study
-
* Corresponding author: Arturo Muriel-Bombín amuriel@hurh.sacyl.es
1 Critical Care Department, Nuevo Hospital Universitario Río Hortega, Calle Dulzaina s/n, 47012 Valladolid, Spain
2 CIBER de Enfermedades Respiratorias (Instituto de Salud Carlos III), Carretera Soller Km. 12, 07110 Mallorca, Spain
3 Critical Care Department, Hospital Clínico Universitario de Salamanca, Paseo de San Vicente 182, 37007 Salamanca, Spain
4 Critical Care Department, Hospital Central de Asturias, Calle Celestino Villamil s/n, Oviedo, 33006 Asturias, Spain
5 Critical Care Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal 3, 47005 Valladolid, Spain
6 Critical Care Department, Hospital Río Carrión, Calle Donantes de Sangre s/n, 34005 Palencia, Spain
7 Critical Care Department, Hospital General de Soria, Carretera de Logroño s/n, 42004 Soria, Spain
8 Critical Care Department, Complejo Hospitalario de León, Calle Altos de Nava s/n, 24008 León, Spain
9 Critical Care Department, Hospital de San Agustín, Camino Heros 4, Avilés, 33410 Asturias, Spain
10 Critical Care Department, Hospital General Yagüe, Avenida del Cid Campeador 96, 09005 Burgos, Spain
11 Critical Care Department, Hospital General de Segovia, Carretera de Avila s/n, 40002 Segovia, Spain
12 Critical Care Department, Hospital Virgen de la Concha, Avenida Requejo 35, 49022 Zamora, Spain
13 Critical Care Department, Hospital de Cabueñes, Calle de los Prados 395, Gijón, 33394 Asturias, Spain
14 Critical Care Department, Hospital del Bierzo, Calle Médicos sin Fronteras 7, Ponferrada, 24411 León, Spain
15 Statistics Department, School of Medicine (University of Valladolid), Avenida Ramón y Cajal 7, 47005 Valladolid, Spain
16 Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
17 Keenan Research Center, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
Critical Care 2008, 12:R158 doi:10.1186/cc7157
See related commentary by Esper and Martin, http://ccforum.com/content/13/1/120
Published: 17 December 2008Abstract
Introduction
Sepsis 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.
Methods
We 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.
Results
A 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.
Conclusions
We 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.