Severe SepsisOrgan DysfunctionHospital MortalityStandardize Mortality RatioSepsis Patient
A multicentre, prospective, observational study was conducted in 12 intensive therapy units (ITUs) in India from June 2006 to November 2006 to determine the incidence and outcome of severe sepsis among adult patients.
All patients admitted to ITUs were screened daily for SIRS, organ dysfunction and severe sepsis. Patients with severe sepsis were further studied.
A total of 1,344 ITU admissions were studied. There were no SIRS in 31.3% and SIRS without organ dysfunction in 51.6%. SIRS with organ dysfunction was found in 230 (17.1%) patients, of which 54 (23.5%) were not due to sepsis and 176 (76.5%) were due to sepsis. The incidence of severe sepsis was 13.1% of all admissions. The mean age of the study population was 54.9 years (SD 17.6), of which 67% were male. The median APACHE II score was 22 (IQR 17–28) with predominant (88%) medical admission. ITU mortality of all admissions was 13.9% and that of severe sepsis was 54.1%. Hospital mortality and 28-day mortality of severe sepsis were 59.3% and 57.6%, respectively. The standardized mortality ratio of severe sepsis patients was 1.40. The median duration of stay in ITUs of the severe sepsis cohort who survived was 6 days (IQR 3–12). The number of episodes where infection was the primary reason for admission to the ITU was 89.8% and the rest of episodes were ITU acquired. See Figure 1 for infection characteristics.
Sepsis was common in Indian ITUs and had predominant medical populations. ITU mortality was higher compared with western literature. Gram-positive infections were less common although the incidence of parasitic and viral infections were higher than in the West.