Critical Care

, 6:P242 | Cite as

The extent and effect of sepsis in the first 24-hours of intensive care in one country

  • FN MacKirdy
  • JA Davidson
  • SJ Mackenzie
Meeting abstract
  • 616 Downloads

Keywords

Intensive Care Unit Community Health Poor Quality Severe Sepsis Hospital Discharge 

Introduction

The PROWESS [1] study reported the development of an apparently successful, but expensive, treatment for severe sepsis. All but two of the 26 adult, general intensive care units (ICUs) in Scotland participated in a prospective audit of admissions during 1999 and 2000. We reviewed our data to assess the extent and effect of sepsis, evident in the first day of intensive care, in this 2-year period.

Results

Almost 40% of all patients were septic within the first 24 hours of ICU admission, and 44% of these had severe sepsis (18% of all admissions). This proportion was consistent in both 1999 and 2000. The ICU mortality was 30% in the sepsis group and 50% in the severe sepsis group, compared to an overall Scottish ICU mortality of 21.5%. A further 9% die before hospital discharge. Although this attrition rate is similar to that in the general ICU population, it means that patients with severe sepsis are twice as likely to die before hospital discharge as the general ICU population. Patients with severe sepsis have higher APACHE II scores (mean 25) compared to those with sepsis (21) or the ICU population in general (19) and stay in ICU longer (mean increase 1.8 days, median 1.1). The standardised mortality ratio (SMR) of 1.16 in the severe sepsis group is clearly of concern, but is unlikely to be due to poor quality of care since the SMRs for Scottish ICUs are known to be in line with expectation [2].

Conclusion

Severe sepsis has important consequences for individual patients, ICU resources and community health. There is the potential for new therapies to make a significant impact on all of these but close surveillance on a national rather than selective basis will be required to assess the cost and benefit.
Table 1

Summary of data collected during 1999 and 2000 in Scottish ICUs

  

All admissions (n = 16,000)

Sepsis (n = 6504)

Severe sepsis (n = 2892)

LOS (days)

Median/mean

1.8/4.53

2.2/5.26

2.9/6.3

Age (years)

Mean

58.3

57.9

61.4

Mortality (%)

ICU/hospital

21.5/29.9

29.6/38.6

50.4/58.7

APACHE II

Probability (%)

33.0

38.5

50.1

 

SMR (95% CI)

0.905 (0.884-0.927)

0.990 (0.970-1.01)

1.16 (1.12-1.19)

References

  1. 1.
    Bernard GR, Vincent J-L, Laterre P-F, et al.: N Engl J Med 2001, 344: 699-709. 10.1056/NEJM200103083441001CrossRefPubMedGoogle Scholar
  2. 2.
    Livingston BM, MacKirdy FN, Howie JC, Jones R, Norrie JD: Crit Care Med 2000, 28: 1820-1827. 10.1097/00003246-200006000-00023CrossRefPubMedGoogle Scholar

Copyright information

© Biomed central limited 2001

Authors and Affiliations

  • FN MacKirdy
    • 1
  • JA Davidson
    • 1
  • SJ Mackenzie
    • 1
  1. 1.Scottish Intensive Care Society Audit Group, Anaesthetic DepartmentVictoria InfirmaryGlasgowUK

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