Brazilian Sepsis Epidemiological Study (BASES study)

Eliézer Silva¹ , Marcelo de Almeida Pedro² , Ana Cristina Beltrami Sogayar³ , Tatiana Mohovic³ , Carla Lika de Oliveira Silva⁴ , Mariano Janiszewski² , Ruy Guilherme Rodrigues Cal² , Érica Fernandes de Sousa⁵ , Thereza Phitoe Abe⁴ , Joel de Andrade⁶ , Jorge Dias de Matos⁷ , Ederlon Rezende⁸ , Murillo Assunção⁹ , Álvaro Avezum² , Patrícia CS Rocha¹⁰ , Gustavo Faissol Janot de Matos² , André Moreira Bento² , Alice Danielli Corrêa¹¹ , Paulo Cesar Bastos Vieira¹² and Elias Knobel¹³

¹Supervisor, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil; Associate Professor, Medical School, Santo Amaro University, São Paulo, Brazil

²Staff Member, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

³Resident of Internal Medicine, Medical School, Santo Amaro University, São Paulo, Brazil

⁴Research Nurse, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

⁵Fellow, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

⁶Head, Intensive Care Unit, University Hospital, Federal University of Santa Catarina, Florianopolis, Brazil

⁷Staff Member, Intensive Care Unit, Hospital Governador Celso Ramos, Florianopolis, Brazil

⁸Head, Intensive Care Unit, Hospital dos Servidores do Estado São Paulo, Brazil

⁹Staff Member, Intensive Care Unit, Hospital dos Servidores do Estado, São Paulo, Brazil

¹⁰Research Nurse, Intensive Care Unit, Medical School, Santo Amaro University, São Paulo, Brazil

¹¹Staff Member, Intensive Care Unit, University Hospital, Federal University of Santa Catarina, Florianopolis, Brazil

¹²Head, Intensive Care Unit, Medical School, Santo Amaro University, São Paulo, Brazil

¹³Head, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

author email corresponding author email

Critical Care 2004, 8:R251-R260doi:10.1186/cc2892


Published:	15 June 2004

See related commentary: http://ccforum.com/content/8/4/222

Abstract

Introduction

Consistent data about the incidence and outcome of sepsis in Latin American intensive care units (ICUs), including Brazil, are lacking. This study was designed to verify the actual incidence density and outcome of sepsis in Brazilian ICUs. We also assessed the association between the Consensus Conference criteria and outcome

Methods

This is a multicenter observational cohort study performed in five private and public, mixed ICUs from two different regions of Brazil. We prospectively followed 1383 adult patients consecutively admitted to those ICUs from May 2001 to January 2002, until their discharge, 28th day of stay, or death. For all patients we collected the following data at ICU admission: age, gender, hospital and ICU admission diagnosis, APACHE II score, and associated underlying diseases. During the following days, we looked for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock criteria, as well as recording the sequential organ failure assessment score. Infection was diagnosed according to CDC criteria for nosocomial infection, and for community-acquired infection, clinical, radiological and microbiological parameters were used.

Results

For the whole cohort, median age was 65.2 years (49–76), median length of stay was 2 days (1–6), and the overall 28-day mortality rate was 21.8%. Considering 1383 patients, the incidence density rates for sepsis, severe sepsis and septic shock were 61.4, 35.6 and 30.0 per 1000 patient-days, respectively. The mortality rate of patients with SIRS, sepsis, severe sepsis and septic shock increased progressively from 24.3% to 34.7%, 47.3% and 52.2%, respectively. For patients with SIRS without infection the mortality rate was 11.3%. The main source of infection was lung/respiratory tract.

Conclusion

Our preliminary data suggest that sepsis is a major public health problem in Brazilian ICUs, with an incidence density about 57 per 1000 patient-days. Moreover, there was a close association between ACCP/SCCM categories and mortality rate.