Log in | Register

Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units

Simon Finfer| Rinaldo Bellomo| Jeffrey Lipman| Craig French| Geoffrey Dobb| John Myburgh
Original
Volume 30, Issue 4 / April , 2004

Pages 589 - 596

Abstract

Objective

To determine the population incidence and outcome of severe sepsis occurring in adult patients treated in Australian and New Zealand intensive care units (ICUs), and compare with recent retrospective estimates from the USA and UK.

Design

Inception cohort study.

Setting

Twenty-three closed multi-disciplinary ICUs of 21 hospitals (16 tertiary and 5 university affiliated) in Australia and New Zealand.

Patients

A total of 5878 consecutive ICU admission episodes.

Measurements and results

Main outcome measures were population-based incidence of severe sepsis, mortality at ICU discharge, mortality at 28 days after onset of severe sepsis, and mortality at hospital discharge. A total of 691 patients, 11.8 (95% confidence intervals 10.9–12.6) per 100 ICU admissions, were diagnosed with 752 episodes of severe sepsis. Site of infection was pulmonary in 50.3% of episodes and abdominal in 19.3% of episodes. The calculated incidence of severe sepsis in adults treated in Australian and New Zealand ICUs is 0.77 (0.76–0.79) per 1000 of population. 26.5% of patients with severe sepsis died in ICU, 32.4% died within 28 days of the diagnosis of severe sepsis and 37.5% died in hospital.

Conclusion

In this prospective study, 11.8 patients per 100 ICU admissions were diagnosed with severe sepsis and the calculated annual incidence of severe sepsis in adult patients treated in Australian and New Zealand ICUs is 0.77 per 1000 of population. This figure for the population incidence falls in the lower range of recent estimates from retrospective studies in the U.S. and the U.K.

Keywords

References

  1. Perl TM, Dvorak L, Hwang T, Wenzel RP (1995) Long-term survival and function after suspected gram-negative sepsis. J Am Med Assoc 274:338–345
    • View reference on publisher's website
  2. Heyland DK, Hopman W, Coo H, Tranmer J, McColl MA (2000) Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life [comment]. Crit Care Med 28:3599–3605
    • View reference on PubMed
  3. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310
    • View reference on PubMed
  4. From the Centers for Disease Control (1990) Increase in national hospital discharge survey rates for septicemia--United States, 1979–1987. J Am Med Assoc 263:937–938
    • View reference on publisher's website
  5. Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Regnier B (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. J Am Med Assoc 274:968–974
    • View reference on publisher's website
  6. Pittet D, Rangel-Frausto S, Li N, Tarara D, Costigan M, Rempe L, Jebson P, Wenzel RP (1995) Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med 21:302–309
    • View reference on PubMed
  7. Salvo I, de Cian W, Musicco M, Langer M, Piadena R, Wolfler A, Montani C, Magni E (1995) The Italian SEPSIS study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock. Intensive Care Med 21 (Suppl 2):S244–S249
    • View reference on PubMed
  8. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554
    • View reference on publisher's website
    • View reference on PubMed
  9. Padkin A, Goldfrad C, Brady A, Young D, Black N, Rowan K (2003) Epidemiology of severe sepsis occurring in the first 24 h in intensive care units in England, Wales, and Northern Ireland. Crit Care Med 31:2332–2338
    • View reference on publisher's website
    • View reference on PubMed
  10. Finfer S, Myburgh J, Bellomo R (2001) The ANZICS Clinical Trials Group 1994–2001: developing a unique research strategy. World Federation J Crit Care Congr Edn, pp 14–17
  11. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655
    • View reference on PubMed
  12. Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709
    • View reference on PubMed
  13. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
    • View reference on PubMed
  14. Joint Faculty of Intensive Care Medicine ANZCA and RACP. Minimum Standards for Intensive Care Units 1997. http://www.jficm.anzca.edu.au/publications/policy/index.htm. Accessed 30 October 2003
  15. Anderson T, Hart G (2001) Reviews of Intensive Care Activity 1999/2000. http://www.anzics.com.au/admc/files/arcccr_00report.pdf. Accessed 30. October
  16. Australian Bureau of Statistics. http://www.abs.gov.au. Accessed 30 October 2003
  17. Statistics New Zealand. http://www.stats.govt.nz. Accessed 30 October 2003
  18. Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, Parsonnet J, Panzer R, Orav EJ, Snydman DR (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. J Am Med Assoc 278:234–240
    • View reference on publisher's website
  19. Vincent JL (1997) Dear Sirs, I’m sorry to say that I don’t like you... Crit Care Med 25:372–374
    • View reference on PubMed
  20. Abraham E, Matthay MA, Dinarello CA, Vincent JL, Cohen J, Opal SM, Glauser M, Parsons P, Fisher CJ Jr, Repine JE (2000) Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: time for a reevaluation. Crit Care Med 28:232–235
  21. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2001) SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 29:530–538

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement