Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study

Alberti, Corinne; Brun‐Buisson, Christian; Burchardi, H.; Martin, Claudio M.; Goodman, Sergey; Artigas, Antonio; Sicignano, A.; Palazzo, M. G. A.; Moreno, Rui P.; Boulmé, Ronan; Lepage, Éric; Gall, J. R. Le

doi:10.1007/s00134-001-1143-z

Cited by 829 publications

(612 citation statements)

References 33 publications

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“…The SAPS 3 database represents a large cohort, comprising critically ill patients from several countries worldwide, with a rate of infection or sepsis at ICU admission (20.9%) comparable to other recent cohort studies such as the European Sepsis Project [16]. Recently Vincent et al found an even higher incidence of 37.4%, but with a broad variation between countries: from 18% in Switzerland to 73% in Portugal [25].…”

Section: Discussionmentioning

confidence: 73%

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Sepsis mortality prediction based on predisposition, infection and response

et al. 2007

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Objective: To empirically test, based on a large multicenter, multinational database, whether a modified PIRO (predisposition, insult, response, and organ dysfunction) concept could be applied to predict mortality in patients with infection and sepsis. Design: Substudy of a multicenter multinational cohort study (SAPS 3). Patients: A total of 2,628 patients with signs of infection or sepsis who stayed in the ICU for > 48 h. Three boxes of variables were defined, according to the PIRO concept. Box 1 (Predisposition) contained information about the patient's condition before ICU admission. Box 2 (Injury) contained information about the infection at ICU admission. Box 3 (Response) was defined as the response to the infection, expressed as a Sequential Organ Failure Assessment score after 48 h. Interventions: None. Main measurements and results: Most of the infections were community acquired (59.6%); 32.5% were hospital acquired. The median age of the patients was 65 (50-75) years, and 41.1% were female. About 22% (n = 576) of the patients presented with infection only, 36.3% (n = 953) with signs of sepsis, 23.6% (n = 619) with severe sepsis, and 18.3% (n = 480) with septic shock. Hospital mortality was 40.6% overall, greater in those with septic shock (52.5%) than in those with infection (34.7%). Several factors related to predisposition, infection and response were associated with hospital mortality. Conclusion: The proposed three-level system, by using objectively defined criteria for risk of mortality in sepsis, could be used by physicians to stratify patients at ICU admission or shortly thereafter, contributing to a better selection of management according to the risk of death.

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Section: Discussionmentioning

confidence: 73%

“…Sepsis, defined as the systemic reaction to infection [1], remains an important cause of morbidity and mortality in ICUS worldwide [16][17][18]. Despite the development of new therapies and integrated approaches for diagnosis and care of the patient with sepsis [19], mortality remains high [17].…”

Section: Discussionmentioning

confidence: 99%

Sepsis mortality prediction based on predisposition, infection and response

et al. 2007

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“…1,2 Despite several decades of intense therapeutic investigation, the mortality from severe sepsis and septic shock remains between 30 and 60%. 3,4 Fluid resuscitation is an integral component of early treatment, as several litres of fluid may be administered in the first hours of severe sepsis and septic shock. 5 In a landmark randomized controlled trial of goal directed therapy in early septic shock, the goal directed group received more intravenous fluid, red blood cells, and dobutamine as compared to the standard therapy group.…”

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confidence: 99%

Resuscitating patients with early severe sepsis: A Canadian multicentre observational study

McIntyre

Fergusson

Cook

et al. 2007

Can J Anesth/J Can Anesth

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Background: Fluid resuscitation is a key factor in restoring hemodynamic stability and tissue perfusion in patients with severe sepsis. We sought to examine associations of the quantity and type of fluid administered in the first six hours after identification of severe sepsis and hospital mortality, intensive care unit (ICU) mortality, and organ failure. Methods:A retrospective, multicentre cohort study was undertaken at five Canadian tertiary care ICUs. We identified patients with severe sepsis admitted to the ICU between July 1, 2000, and June 30, 2002, using both administrative and clinical databases. Patients were included if they were hypotensive, had an infectious source, and at least two systemic inflammatory response syndrome criteria. We recorded total quantity and type of fluid administered for the first six hours after severe sepsis was identified. The first episode of hypotension defined the starting point for collection of fluid data. Multivariable regression analyses were performed to examine associations between quantity and type of fluid administered and hospital/ICU mortality, and organ failure.Results: Of 2,026 potentially eligible patient charts identified, 496 patients met eligibility criteria. The mean age and Acute Physiology and Chronic Health Evaluation score (APACHE II) were 61.8 ± 16.5 yr and 29.0 ± 8.0, respectively. No associations between quantity or type of fluid administered and hospital mortality or ICU mortality were identified, and there were no statistically significant associations between quantity or type of fluid administered and organ failure. However, more fluid resuscitation was associated with an increased risk of cardiovascular failure [odds ratio (OR) and 95% confidence interval Conclusion:An association between hospital mortality and quantity or type of fluid administered in the first six hours after the diagnosis of severe sepsis was not identifiable. These findings should be considered as hypothesis-generating and warrant confirmation or refutation by randomized controlled trials.

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“…Important to note is that the mortality rates in these subgroups of patients are similar to the general ICU patients with severe infection 57 regardless of the recent administration of chemotherapy 43 .…”

Section: Prognostic Indicators: Subgroups With a Better And Worse Outmentioning

confidence: 88%

Outcome in critically ill cancer patients: past and present

Benoît¹,

Depuydt²

2008

Rev. bras. ter. intensiva

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RESUMO JUSTIFICATIVA E OBJETIVOS: Até o final do século passado, havia grande incerteza quanto a propriedade de internar pacientes com câncer em unidades de terapia intensiva (UTI) para medidas de suporte avançado. Contudo, ao longo dos últimos anos, vários centros ao redor do mundo têm reportado aumento significativo da sobrevida de tais pacientes. O objetivo deste estudo foi rever os principais artigos publicados nas duas últimas décadas, com foco na melhoria do prognóstico de pacientes com câncer criticamente enfermos. CONTEÚDO: Realizou-se uma busca bibliográfica no sistema MedLine -PubMed (www.pubmed.gov) para identificar artigos em linguagem inglesa sobre cuidados intensivos no pacientes com tumores sólidos ou neoplasias hematológicas, com ênfase no prognóstico e no tratamento. Utilizaram-se os seguintes unitermos: cancer, solid tumor, hematologic or hematological malignancies, immunosupression, ICU, ventilation, organ failure, sepsis and infection. Estudos referenciados nos artigos selecionados na busca também foram utilizados. CONCLUSÕES: O tema será abordado de forma sistematizada. Inicialmente, haverá uma discussão sobre o prognóstico sombrio experimentado por estes pa-

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Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study

Abstract: The crude incidence of ICU infections remains high, although the rate varies between ICUs and patient subsets, illustrating the added burden of nosocomial infections in the use of ICU resources.

Cited by 829 publications

References 33 publications

Sepsis mortality prediction based on predisposition, infection and response

Sepsis mortality prediction based on predisposition, infection and response

Resuscitating patients with early severe sepsis: A Canadian multicentre observational study

Outcome in critically ill cancer patients: past and present

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