Skip to main content

Comparing intensive care treated primary, secondary and tertiary sepsis with respect to length of stay, organ failure and mortality: a pilot study


It may be hypothesized that a patient's inflammatory status might affect the clinical picture and outcome of a subsequent septic insult. To test this hypothesis, patients were categorized according to previous inflammatory activity and analyzed with respect to clinical picture and outcome in a retrospective study.


The Swedish ICU registry was used to identify all adult patients diagnosed with severe sepsis or septic shock in a single Swedish ICU during 2006 to 2011. The charts were reviewed and patients categorized into four groups based on whether the patient had suffered systemic inflammatory-inducing insults previous to the septic episode. The patients were categorized as: (A) primary sepsis, no recent (<30 days) trauma/infection, ongoing systemic inflammatory or immunosuppressive disease or malnutrition; (B) secondary sepsis, recent (<7 days) trauma/infection or systemic inflammatory disease, but no immunosuppressive disease or malnutrition; (C) tertiary sepsis, >1 fulfilled criteria of secondary sepsis during the last 10 days or immunosuppressive disease or malnutrition; and (D) patients not attributable to A to C. After the categorization, physiological and laboratory parameters during the ICU stay as well as therapy and outcome were extracted from the charts. Only significant differences (P 0.05) are presented; Mann-Whitney and chi-squared tests were used.


A total of 273 charts were reviewed. In total, 242 were categorized into A (n = 126), B (n = 79) or C (n = 37). D (n = 31) consisted mainly of patients with hematological malignancies (n = 12) and patients with chemotherapy or immunosuppressive treatment (n = 14). The groups differed in length of stay with A< B< C. During the first 3 days the SOFA score was higher in A compared with C and in B compared with C. The duration of antibiotic therapy was longer in both B and C compared with A. There were no differences in 28-day mortality (A: 34/126 = 27%, B: 30/79 = 38%, C: 15/37 = 40%); however, the proportions of patients dying between days 8 and 28 were higher in B (14/63 = 22%) and C (7/29 = 24%) compared with A (5/95 = 5%).


In this retrospective material it was possible to categorize 88.6% of all patients as having primary, secondary or tertiary sepsis. The categories differed in clinical picture at presentation as well as in outcome. A prospective study is warranted to validate the results of this study.

Author information



Corresponding author

Correspondence to S Castegren.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Castegren, S., Jonasson, M., Sjölin, J. et al. Comparing intensive care treated primary, secondary and tertiary sepsis with respect to length of stay, organ failure and mortality: a pilot study. Crit Care 17, P475 (2013).

Download citation


  • Septic Shock
  • Severe Sepsis
  • Organ Failure
  • Clinical Picture
  • Hematological Malignancy