A prospective, observational severe sepsis/septic shock registry in a tertiary hospital in the province of Guipuzcoa (Spain)

Abstract

ObjectiveTo determine the epidemiological and clinical characteristics of the patients with severe sepsis/septic shock admitted to the Intensive Care Unit (ICU) of Donostia Hospital (Guipuzcoa, Spain), analyzing the prognostic factors and comparing them with the existing data at national level. DesignA prospective observational study was carried out during a consecutive 3-year period (1 Feb. 2008–31 Dec. 2010). SettingThe ICU of Donostia Hospital, the only third level hospital in the province of Guipúzcoa, with a recruitment population of 700,000 inhabitants. ResultsIn the course of the study period, 6263 patients were admitted to our department: 2880 were non-coronary patients, and 511 suffered a severe sepsis or septic shock episode upon admission or during their stay in the ICU. Males predominated (66.5%), the mean age was 63 years, and the mean Acute Physiology And Chronic Health Evaluation II (APACHE II) score was 21. Most cases were medical (68%) and were admitted from hospital wards (53.5%). The most frequent origin was pneumonia (24%). The great majority of the cases (73%) corresponded to septic shock. Hemodynamic alterations were the most frequent disorders, followed by renal and respiratory impairment. Noradrenalin was used as vasoactive drug in all shock patients; over one-half required mechanical ventilation (MV), and one-third required continuous venous–venous hemodiafiltration (CVVHDF). Interventions frequently used in the management of these patients comprised blood cultures or corticosteroid use, while other measures such as activated protein C were little used. The mortality rate in the ICU was 20.8%, with a mean stay in the Unit of 14 days. The parameters associated to mortality in the multivariate analysis included the presence of hypoglycemia, respiratory dysfunction, the need for MV, lactic acid elevation and thrombocytopenia in the first 24h, together with an origin of sepsis either in the ICU or in the hospital. ConclusionsSevere sepsis is frequent in our unit, generating important morbidity and hospital stay, as well as high mortality. The epidemiological and clinical characteristics of our patients are similar to those described globally at national level. Considering our data in complying with the different treatment measures, it is clear that there is still room for improvement.