Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China.

Jialing Zhou ,Fachun Zhou,Mingyan Zhao,Tiehe Qin,Jiandong Lin,Dawei Wu,Shusheng Li,Li Jiang,Yuhang Ai,Zhenjie Hu,Xiangyuan Cao,Yan Kang,Xiangyou Yu,Chuanyun Qian,Bin Du,Youzhong An,Dexin Liu,Yuan Xu,Xiaochun Ma,Enqiang Mao,Ling Zhou ,Rao Sun ,He Zhen-Yang

doi:10.1371/journal.pone.0107181

Abstract

IntroductionInformation about sepsis in mainland China remains scarce and incomplete. The purpose of this study was to describe the epidemiology and outcome of severe sepsis and septic shock in mixed ICU in mainland China, as well as the independent predictors of mortality.MethodsWe performed a 2-month prospective, observational cohort study in 22 closed multi-disciplinary intensive care units (ICUs). All admissions into those ICUs during the study period were screened and patients with severe sepsis or septic shock were included.ResultsA total of 484 patients, 37.3 per 100 ICU admissions were diagnosed with severe sepsis (n = 365) or septic shock (n = 119) according to clinical criteria and included into this study. The most frequent sites of infection were the lung and abdomen. The overall ICU and hospital mortality rates were 28.7% (n = 139) and 33.5% (n = 162), respectively. In multivariate analyses, APACHE II score (odds ratio[OR], 1.068; 95% confidential interval[CI], 1.027–1.109), presence of ARDS (OR, 2.676; 95%CI, 1.691–4.235), bloodstream infection (OR, 2.520; 95%CI, 1.142–5.564) and comorbidity of cancer (OR, 2.246; 95%CI, 1.141–4.420) were significantly associated with mortality.ConclusionsOur results indicated that severe sepsis and septic shock were common complications in ICU patients and with high mortality in China, and can be of help to know more about severe sepsis and septic shock in China and to improve characterization and risk stratification in these patients.

Highlights

Information about sepsis in mainland China remains scarce and incomplete
Between 6 and 54% of patients admitted to intensive care units (ICUs) have severe sepsis [2,3,6,8,9,10], and the mortality rate for these patients varies from 20 to 60% [6,10,11,12], which will increase stepwise with increasing disease severity [13]
Study development This was a secondary analysis of a prospective cohort study aiming to describe the demographics, case mix, interventions, and clinical outcome of critically ill patients admitted to ICUs in Mainland China and performed from 1 July 2009 to 31 August 2009 in 22 ICUs [15], so the data in the current study were collected prospectively but the analysis was done retrospectively

Summary

Introduction

The purpose of this study was to describe the epidemiology and outcome of severe sepsis and septic shock in mixed ICU in mainland China, as well as the independent predictors of mortality. The mortality rate may have decreased in recent years [5,7], the incidence of severe sepsis and septic shock is increasing, so that overall deaths are increasing [2,4,7]. There have been a number of studies describing the epidemiology, risk factor and outcome of severe sepsis and septic shock in different countries [2,4,7,10,11]. The China Critical Care Clinical Trials Group (CCCCTG) conducted an inception cohort study to investigate the epidemiology and outcome of severe sepsis and septic shock in mixed ICUs in China

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Discussion

Conclusion