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The Italian SEPSIS study: Preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock

I. Salvo| W. de Cian| M. Musicco| M. Langer| R. Piadena| A. Wolfler| C. Montani| E. Magni
Original
Volume 21, Issue 2 / November , 1995

Pages S244 - S249

Abstract

This prospective, multicenter, epidemiological study was carried out in 99 Italian ICUs, distributed throughout the country, from April 1993 to March 1994. In the study, we applied the new ACCP/SCCM classification system for sepsis (SIRS, sepsis, severe sepsis and septic shock) and determined the prevalence, incidence, evolution and outcome of these categories in critically ill patients. The preliminary analysis of 1101 patients showed that on admission SIRS accounted for about half of the diagnoses (52%) with sepsis, severe sepsis and septic shock accounting for 4.5%, 2.1% and 3% of patients, respectively. Patients with severe sepsis or septic shock more frequently had high SAPS scores than patients without sepsis. Mortality rates were similar in patients with SIRS (26.5%) and without SIRS or infection (24%), but rose to 36% in patients with sepsis, to 52% in those with severe sepsis and to 81.8% in those with septic shock. Sepsis, severe sepsis and septic shock were more common in patients with medical diagnoses, and neither severe sepsis nor septic shock was observed in trauma patients. With respect to evolution, the incidence of septic shock was progressively higher in patients admitted with more severe “sepsis-related” diagnoses, while only a trivial difference in rates of incidence was observed between SIRS patients and those admitted without SIRS or any septic disorder (nil). The breakdown of the various ACCP/SCCM “sepsis-related” diagnoses at any time during the study was: SIRS in 58% of the population, sepsis in 16.3%, severe sepsis in 5.5% and septic shock in 6.1%. It seems reasonable to expect from the final evaluation of our study answers to the questions raised by the ACCP/SCCM Consensus Conference about the correlations between “sepsis-related” diagnosis, severity score, organ dysfunction score and outcome.

Keywords

EpidemiologySepsisICUSIRS

References

  1. Bone RC (1991) The pathogenesis of sepsis. Ann Intern Med 115:457–492
  2. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–874
  3. Parrillo JE (1993) Pathogenetic mechanism of septic shock. N Engl J Med 328:1471–1477
  4. European Society of Intensive Care Medicine (1994) The problem of sepsis. Intensive Care Med 20:300–304
  5. Knaus WA, Sun X, Nystrom PO, Wagner DP (1992) Evaluation of definitions for sepsis. Chest 101: 1656–1662
  6. Ziegler EJ, Fisher CJ, Sprung CL, et al (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. N Engl J Med 324:429–436
  7. Greenman RL, Schein, RMH, Martin MA, et al (1991) A controlled trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram negative sepsis. JAMA 266:1097–1102
  8. Vincent JL, Bakker J, Marecaux G, Schandene L, Kahn RJ, Dupont E (1991) Administration of anti-TNF antibody improves left ventricular function in septic shock patients. Chest 101:810–815
  9. Fisher CJ, Opal SM, Dhainaut JF, Stephens S, Zimmerman JL, Nightngale P, Harris SJ, Schein RMH, Panacek EA, Vincent JL, Foulke GE, Warren EL, Guarard C, Park G, Bodmer MW, Cohen J, Van der Linden C, Cross AS, Sadoff JC, the CB006 Sepsis Syndrome Study Group (1993) Influence of an anti-tumor necrosis factor monoclonal antibody on cytokine levels in patients with sepsis. Crit Care Med 21:318–327
  10. Fisher CJ, Slotman GJ, Opal SM, Pribble J, Bohe RC, Emanuel G, Ng D, Bloedow DC, Catalano MA (1994) Initial evaluation of human recombinant interleukin receptor antagonist in the treatment of sepsis syndrome: a randomized, open label, placebo controlled multicenter trial. Crit Care Med 22:12–21
  11. Pribble J, Fisher CJ, Opal S, Balk R, Slotman G, Reines D, Shelly M, Dhainaut JF, Stiles D, Knaus W, Sadoff J, Labrecque J (1994) Human recombinant interleukin 1 receptor antagonist increases survival time in patients with sepsis syndrome and end organ dysfunction. Crit Care Med 22:A192
  12. Bone RC (1992) Sepsis, the sepsis syndrome, multiorgan failure: a plea for comparable definitions. Ann Intern Med 114:332–333
  13. McGabe WR, Jackson GG (1962) Gram negative bacteremia: aetiology and ecology. Arch Intern Med 110: 845–853
  14. Le Gall JR, Loirat P, Alperovich A, Glaer P, Granthill C, Mathieu D, Mercier P, Thomas R, Villers D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12: 975–977
  15. Goris RJA, Boekhorst TPA, Niytink JKS, Gimbrere JSF (1985) Multiple organ failure: generalized autodestructive inflammation? Arch Surg 120: 1109–1114

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