Medline ® Abstracts for References 2-5
of 'Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis'
Elixhauser A, Friedman B, Stranges E. Septicemia in U.S. Hospitals, 2009. Agency for Healthcare Research and Quality, Rockville, MD http://www.hcup-us.ahrq.gov/reports/statbriefs/sb122.pdf (Accessed on February 15, 2013).
no abstract available
Utilization patterns and outcomes associated with central venous catheter in septic shock: a population-based study.
Walkey AJ, Wiener RS, Lindenauer PK
Crit Care Med. 2013;41(6):1450.
OBJECTIVES: In 2001, a randomized trial showed decreased mortality with early, goal-directed therapy in septic shock, a strategy later recommended by the Surviving Sepsis Campaign. Placement of a central venous catheter is necessary to administer goal-directed therapy. We sought to evaluate nationwide trends in: 1) central venous catheter utilization and 2) the association between early central venous catheter insertion and mortality in patients with septic shock.
DESIGN: We retrospectively analyzed the proportion of septic shock cases receiving an early (day of admission) central venous catheter and the odds of hospital mortality associated with receiving early central venous catheter from years 1998 to 2001 compared with 2002 to 2009.
SETTING: Non-federal acute care hospitalizations from the Nationwide Inpatient Sample, 1998-2009.
PATIENTS: A total of 203,481 (population estimate: 999,545) patients admitted through an emergency department with principal diagnosis of septicemia and secondary diagnosis of shock.
MEASUREMENTS AND MAIN RESULTS: From 1998 to 2009, population-adjusted rates of septic shock increased from 12.6 cases per 100,000 U.S. adults to 78 cases per 100,000. During this time, age-adjusted hospital mortality associated with septic shock declined from 40.4% to 31.4%. Early central venous catheter insertion increased from 5.7% (95% confidence interval 5.1% to 6.3%) to 19.2% (95% confidence interval 18.7% to 19.5%) cases with septic shock, with an increased rate of early central venous catheter placement identified after 2007. The rate of decline in age-adjusted hospital mortality was significantly greater for patients who received an early central venous catheter (-4.2% per year, 95% confidence interval -3.2, -4.2%) as compared with no central venous catheter (-2.9% per year, 95% confidence interval -2.3, -3.5%; p = 0.016). Hospital mortality associated with early central venous catheter insertion significantly decreased from a multivariable-adjusted odds ratio of 1.29 (95% confidence interval 1.14-1.45) prior to 2001 to an adjusted odds ratio of 0.87 (95% confidence interval 0.84-0.90) after 2001.
CONCLUSIONS: Placement of a central venous catheter early in septic shock has increased three-fold since 1998. The mortality associated with early central venous catheter insertion decreased after publication of evidence-based instructions for central venous catheter use.
The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA. firstname.lastname@example.org
Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.
Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R
IMPORTANCE: Severe sepsis and septic shock are major causes of mortality in intensive care unit (ICU) patients. It is unknown whether progress has been made in decreasing their mortality rate.
OBJECTIVE: To describe changes in mortality for severe sepsis with and without shock in ICU patients.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective, observational study from 2000 to 2012 including 101,064 patients with severe sepsis from 171 ICUs with various patient case mix in Australia and New Zealand.
MAIN OUTCOMES AND MEASURES: Hospital outcome (mortality and discharge to home, to other hospital, or to rehabilitation).
RESULTS: Absolute mortality in severe sepsis decreasedfrom 35.0% (95% CI, 33.2%-36.8%; 949/2708) to 18.4% (95% CI, 17.8%-19.0%; 2300/12,512; P < .001), representing an overall decrease of 16.7% (95% CI, 14.8%-18.6%), an annual rate of absolute decrease of 1.3%, and a relative risk reduction of 47.5% (95% CI, 44.1%-50.8%). After adjusted analysis, mortality decreased throughout the study period with an odds ratio (OR) of 0.49 (95% CI, 0.46-0.52) in 2012, using the year 2000 as the reference (P < .001). The annual decline in mortality did not differ significantly between patients with severe sepsis and those with all other diagnoses (OR, 0.94 [95% CI, 0.94-0.95]vs 0.94 [95% CI, 0.94-0.94]; P = .37). The annual increase in rates of discharge to home was significantly greater in patients with severe sepsis compared with all other diagnoses (OR, 1.03 [95% CI, 1.02-1.03]vs 1.01 [95% CI, 1.01-1.01]; P < .001). Conversely, the annual increase in the rate of patients discharged to rehabilitation facilities was significantly less in severe sepsis compared with all other diagnoses (OR, 1.08 [95% CI, 1.07-1.09]vs 1.09 [95% CI, 1.09-1.10]; P < .001). In the absence of comorbidities and older age, mortality was less than 5%.
CONCLUSIONS AND RELEVANCE: In critically ill patients in Australia and New Zealand with severe sepsis with and without shock, there was a decrease in mortality from 2000 to 2012. These findings were accompanied by changes in the patterns of discharge to home, rehabilitation, and other hospitals.
Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia2Critical Care Research Group, Intensive Care Unit, Helsinki University Central Hospital, Hels.
Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010.
McPherson D, Griffiths C, Williams M, Baker A, Klodawski E, Jacobson B, Donaldson L
BMJ Open. 2013;3(8) Epub 2013 Aug 2.
OBJECTIVES: To quantify mortality associated with sepsis in the whole population of England.
DESIGN: Descriptive statistics of multiple cause of death data.
SETTING: England between 2001 and 2010.
PARTICIPANTS: All people whose death was registered in England between 2001 and 2010 and whose certificate contained a sepsis-associated International Classification of Diseases, 10th Revision (ICD-10) code.
DATA SOURCES: Multiple cause of death data extracted from Office for National Statistics mortality database.
STATISTICAL METHODS: Age-specific and sex-specific death rates and direct age-standardised death rates.
RESULTS: In 2010, 5.1% of deaths in England were definitely associated with sepsis. Adding those that may be associated with sepsis increases this figure to 7.7% of all deaths. Only 8.6% of deaths definitely associated with sepsis in 2010 had a sepsis-related condition as the underlying cause of death. 99% of deaths definitely associated with sepsis have one of the three ICD-10 codes-A40, A41 and P36-in at least one position on the death certificate. 7% of deaths definitely associated with sepsis in 2001-2010 did not occur in hospital.
CONCLUSIONS: Sepsis is a major public health problem in England. In attempting to tackle the problem of sepsis, it is not sufficient to rely on hospital-based statistics, or methods of intervention, alone. A robust estimate of the burden of sepsis-associated mortality in England can be made by identifying deaths with one of the three ICD-10 codes in multiple cause of death data. These three codes could be used for future monitoring of the burden of sepsis-associated mortality.
Imperial College London, London, UK.