An epidemiological study of sepsis in ICUs: Sepsis Brazil Study

Introduction

Sepsis represents the major cause of death in the ICUs all over the world and is a major challenge in these units. Many studies had been shown an increasing incidence over time and only a slight reduction in mortality. Many new treatment strategies are arising and we should know our incidence of sepsis and features.

Methods

A prospective cohort study was conducted in 65 hospitals of all regions of Brazil. The patients who were admitted or who developed sepsis during the month of September 2003 were enrolled. They were followed until the 28th day or less according to their discharge. The diagnoses were made in accordance with the criteria proposed by ACCP/SCCM. The final classification was made considering the worse stage in the first 4 days after the diagnosis of sepsis. Parameters evaluated were demographic features, APACHE II score, SOFA (Sepsis-related Organ Failure Assessment) score, mortality, sources of infections, microbiology and interventions. Also recorded was underlying diseases and length of stay (LOS).

Results

A total of 3128 patients were identified and 526 (17%) filled the criteria of sepsis, severe sepsis or septic shock. Two hundred and sixty-six (50.6%) patients had septic shock, 157 (30%) severe sepsis, and 102 (19.4%) had sepsis. The average age was 61.7 years (SD ± 18.9), 293 (55%) were males, and the overall 28-day mortality rate was 46.2%. The average APACHE II score was 20(SD ± 7.8) and the SOFA score on the first day was 7 (SD ± 3.8). The SOFA score on the mortality group was higher on day 1 (8), and had increased on day 3. The mortality rate for sepsis, severe sepsis and septic shock was 15.7%, 33.8% and 65%, respectively. The average LOS was 16 days. The two main sources of infection were the respiratory tract (50.2%) and the abdomen (16.3%). Gram-negative bacilli were more prevalent (55.6%). Gram-positive cocci accounted for 32% and fungi infections for 5%. Chronic obstructive pulmonary disease was the most frequent underlying disease seen.

Conclusion

A high incidence and mortality of sepsis was observed in ICUs in our country. The high frequency of septic shock and severe sepsis demonstrated a group at high risk of death.