Epidemiology and Outcome of Severe Sepsis and Septic Shock in Intensive Care Units in Mainland China

<div><p>Introduction</p><p>Information about sepsis in mainland China remains scarce and incomplete. The purpose of this study was to describe the epidemiology and outcome of severe sepsis and septic shock in mixed ICU in mainland China, as well as the independent predictors of mortality.</p><p>Methods</p><p>We performed a 2-month prospective, observational cohort study in 22 closed multi-disciplinary intensive care units (ICUs). All admissions into those ICUs during the study period were screened and patients with severe sepsis or septic shock were included.</p><p>Results</p><p>A total of 484 patients, 37.3 per 100 ICU admissions were diagnosed with severe sepsis (n = 365) or septic shock (n = 119) according to clinical criteria and included into this study. The most frequent sites of infection were the lung and abdomen. The overall ICU and hospital mortality rates were 28.7% (n = 139) and 33.5% (n = 162), respectively. In multivariate analyses, APACHE II score (odds ratio[OR], 1.068; 95% confidential interval[CI], 1.027–1.109), presence of ARDS (OR, 2.676; 95%CI, 1.691–4.235), bloodstream infection (OR, 2.520; 95%CI, 1.142–5.564) and comorbidity of cancer (OR, 2.246; 95%CI, 1.141–4.420) were significantly associated with mortality.</p><p>Conclusions</p><p>Our results indicated that severe sepsis and septic shock were common complications in ICU patients and with high mortality in China, and can be of help to know more about severe sepsis and septic shock in China and to improve characterization and risk stratification in these patients.</p></div

Distribution of microorganisms isolated from 148 patients.

<p>*including Burkholderia cepacia, Chryseobacter iumindologenes, Enterobacter cloacae, Enterobacteraerogenes, and Serratialiquefaciens.</p><p>**fungal infection here refers to the invasive fungal infection and fungemia.</p><p>Distribution of microorganisms isolated from 148 patients.</p

Multivariate logistic regression analysis of independent predictors of hospital mortality in patients with severe sepsis and septic shock.

<p>APACHE II, Acute Physiology and Chronic Health Evaluation II; ARDS, Acute respiratory distress syndrome; CI, confidence interval; OR, odds ratio.</p><p>Multivariate logistic regression analysis of independent predictors of hospital mortality in patients with severe sepsis and septic shock.</p

Characteristics and outcome of patients with severe sepsis.

<p>APACHE II, Acute Physiology and Chronic Health Evaluation II; ARDS, acute respiratory distress syndrome; COPD, Chronic obstructive pulmonary disease; ICU, Intensive care unit; IQR, interquartile range; SOFA, Sequential Organ Failure Assessment.</p><p>Characteristics and outcome of patients with severe sepsis.</p

Characteristics of participating ICUs.

<p>ICU, intensive care unit; IQR, interquartile range.</p><p>Characteristics of participating ICUs.</p

The source of infection of patients with severe sepsis (total >100% because 167 patients had more than one infection sites).

<p>The source of infection of patients with severe sepsis (total >100% because 167 patients had more than one infection sites).</p

Flow diagram of enrolled patients and their outcome.

<p>ICU, intensive care unit; LOS, length of stay.</p