Epidemiology and outcome of patients with severe sepsis in six Spanish ICUs

Introduction

The objective of this study was to describe the epidemiology, consumption of resources and outcome of patients with severe sepsis.

Methods

A prospective, observational and multicenter study performed in six Spanish ICUs. Only patients with severe sepsis were included.

Results

A total of 122 patients with severe sepsis were included (female 33.1%; mean age 58.01 ± 15.40 years; mean APACHE II score at admission to the ICU 21.10 ± 8.89). The source of the infection was respiratory in 56.2%, abdominal in 19.2% and other foci in 24.6%. Sepsis-related Organ Failure Assessment (SOFA) scores at the time of diagnosis of severe sepsis were the following: global 10.21 ± 3.75, respiratory 2.66 ± 1.08, haematological 0.75 ± 1.10, hepatic 0.70 ± 1.01, cardiovascular 3.54 ± 1.22, neurological 0.96 ± 1.50, and renal 1.46 ± 1.61. Rates of organ failure were the following: respiratory 93.8%, haematological 38.5%, hepatic 37.7%, cardiovascular 90.8%, neurological 35.4% and renal 55.4%. The rate of use of medical resources was as follows: adrenergic agents 90.8%, mechanical ventilation 86.2%, extrarenal depuration 20% and recombinant activated protein C 15.4%. Mean length of stay in the ICU was 16.88 ± 18.98 days. The mortality rate in the ICU was 43.44%. We found that lactic acid serum levels (OR = 1.26, 95% CI = 1.11 to 1.43, P < 0.001), SOFA score (OR = 1.24, 95% CI = 1.12 to 1.37, P < 0.001) and plasminogen activator inhibitor-1 (PAI-1) plasma levels (OR = 1.02, 95% CI = 1.01 to1.03, P = 0.001) at the time of diagnosis were predictors of mortality.

Conclusion

Severe sepsis is an important cause of mortality and it incurs a considerable use of resources. Lactic acid serum levels, SOFA score and PAI-1 plasma levels at diagnosis were found to be predictors of mortality.