Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

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.

Defining sepsis on the wards: results of a multi‐centre point‐prevalence study comparing two sepsis definitions

“…Sepsis either defined by the SEPSIS‐1 or SEPSIS‐3 criteria had a high mortality; 22.9% of the patients died within 30 days, significantly higher than the 2.2% mortality observed in the group which did not fulfil either criteria for the diagnosis of sepsis. This was almost identical to the 22% 30‐day mortality observed in our previous study, but significantly higher than the 6% and 8% mortality observed in the recent studies involving ED and ward patients . This could probably be explained by methodological differences between studies.…”

“…We prospectively collected data on patients where the clinical teams suspected infection, hence we were able to test the real‐life utility of the new sepsis definition and proposed clinical tools and compared its performance with the already implemented SEPSIS‐1 criteria. Our study has high internal validity as in our subsequent trials using similar methodology we recruited similar number of patients with almost identical outcomes in the same hospitals .…”

“…The strengths of our work include the use of robust, previously published data collection methodology tested over subsequent studies, and the wide participation of centres . We prospectively collected data on patients where the clinical teams suspected infection, hence we were able to test the real‐life utility of the new sepsis definition and proposed clinical tools and compared its performance with the already implemented SEPSIS‐1 criteria.…”

“…We found that 4% of hospitalised patients had sepsis, half of whom had significant organ dysfunction (severe sepsis). Strikingly, the 90‐day mortality among the whole hospital cohort was in excess of 30% for sepsis, and almost 40% for severe sepsis .…”

“…We previously reported the results of a point‐prevalence feasibility study and subsequent study of all Welsh centres using the 1992 International Consensus Criteria for sepsis (SEPSIS‐1), using electronic data collection and real‐time data monitoring . We found that 4% of hospitalised patients had sepsis, half of whom had significant organ dysfunction (severe sepsis).…”