Abstract
Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis). There were 5317 in-patients in the 24-hour study period. Data were returned on 1198 digital data collection forms on patients with NEWS≥3 of which 87 were removed, leaving 1111 for analysis. 146 patients had sepsis and 144 patients had severe sepsis. Combined prevalence of sepsis and severe sepsis was 5.5% amongst all in-patients. Patients with sepsis had significantly higher NEWS scores (3 IQR 3–4 for non-sepsis and 4 IQR 3–6 for sepsis patients, respectively). Common organ dysfunctions in severe sepsis were hypoxia (47%), hypoperfusion (40%) and acute kidney injury (25%). Mortality at 90 days was 31% with a median (IQR) hospital free stay of 78 (36–85) days. Screening for sepsis, referral to Critical Care and completion of Sepsis 6 bundle was low: 26%, 16% and 12% in the sepsis group. Multivariable logistic regression analysis identified higher National Early Warning Score, diabetes, COPD, heart failure, malignancy and current or previous smoking habits as independent variables suggesting the diagnosis of sepsis. We observed that sepsis is more prevalent in the general ward and ED than previously suggested before and that screening and effective treatment for sepsis and severe sepsis is far from being operationalized in this environment, leading to high 90 days mortality.
Highlights
Sepsis is a systemic response to infection, which causes a potentially damaging inflammatory response
Out of these patients 146 had sepsis and 144 had severe sepsis according to the Surviving Sepsis Campaign definition (35 sepsis and 42 severe sepsis in Emergency Departments (ED); 111 sepsis and 102 severe sepsis on the wards, respectively)
This is higher than the 4.4% incidence found in the Esteban study in 2003 and reflects the global increase in the disease burden found in recent analysis of hospital and ICU registries [10,12]. This is the first study in the UK to measure the prevalence of sepsis and severe sepsis in the non-critical care setting, using contemporary data collection methods and utilizing the SCCM Consensus criteria [1]
Summary
Sepsis is a systemic response to infection, which causes a potentially damaging inflammatory response. Successful management of sepsis requires prompt recognition and immediate response with appropriate escalation of care to Critical Care if required [1]. In the UK sepsis is estimated to be responsible for the deaths of 44,000 people every year and to cost the NHS £2.5 billion and for Wales this could equate to a figure of 1800 deaths and a cost of £125 million [2]. Sepsis is a major cause of avoidable mortality and it is imperative that we understand the size of the problem within Wales so that we can improve the quality of care received by our patients
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