Abstract
Background: Sepsis is a main cause of morbidity and mortality in critically ill patients. The epidemiology of sepsis in high-income countries is well-known, but information on sepsis in middle- or low-income countries is still deficient, especially in China. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically ill patients in tertiary hospitals in China.Methods: A multicenter prospective observational cohort study was performed with consecutively collected data from adults who stayed in any intensive care unit (ICU) for at least 24 h; data were collected from 1 January 2014 to 31 August 2015, and patients were followed until death or discharge from the hospital.Results: A total of 4,910 patients were enrolled in the study. Of these, 2,086 (42.5%) presented with sepsis or septic shock on admission to the ICU or within the first 48 h after admission to the ICU. ICU mortality was higher in patients with sepsis (13.1%) and septic shock (39.0%) and varied according to geographical region. Acinetobacter, Pseudomonas, and Staphylococcus infections were associated with increased ICU mortality. In addition, age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, pre-existing cardiovascular diseases, malignant tumors, renal replacement therapy (RRT), and septic shock were independent risk factors for mortality in patients with sepsis. The prompt administration of antibiotics (OR 0.65, 95% CI 0.46–0.92) and 30 mL/kg of initial fluid resuscitation during the first 3 h (OR 0.43, 95% CI 0.30–0.63) improved the outcome in patients with septic shock.Conclusions: Sepsis was common and was associated with a high mortality rate in critically ill patients in tertiary hospitals in China. The prompt administration of antibiotics and 30 mL/kg fluid resuscitation decreased the risk of mortality.
Highlights
Sepsis is a major challenge for public health; it is the main cause of morbidity and mortality in intensive care units (ICUs) and is associated with poor outcomes [1,2,3,4]
A total of 14,604 critically ill patients were consecutively admitted to the ICUs
Achieving the resuscitation goal of 30 ml/kg during the first 3 h and administering antibiotics within 1 h of the onset of septic shock decreased the odds ratio for mortality in patients with septic shock (Table 7)
Summary
Sepsis is a major challenge for public health; it is the main cause of morbidity and mortality in intensive care units (ICUs) and is associated with poor outcomes [1,2,3,4]. Global data from the Intensive Care Over Nations (ICON) audit showed that 29.5% of patients had sepsis during their ICU stay, and the occurrence rates varied regionally from 13.6 to 39.3% [7]. In the United States, mortality due to sepsis decreased from 27.8 to 17.9% between 1979 and 2000 [8]. Sepsis is a main cause of morbidity and mortality in critically ill patients. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically ill patients in tertiary hospitals in China
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