Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

Abstract

ObjectiveThis study aims to provide a case definition of sepsis of presumed bacterial aetiology based on 10th revision of the International Classification of Diseases (ICD-10) codes, to assess trends in sepsis incidence and mortality between 2015 and 2019 in France, and to describe the characteristics of affected patients and hospital stays.DesignNationwide, population-based, retrospective observational study.SettingMetropolitan France between 2015 and 2019.ParticipantsBetween 2015 and 2019, 1 224 433 patients with sepsis of presumed bacterial aetiology were selected from the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d’Information) and were identified from corresponding ICD-10 codes for explicit sepsis or implicit sepsis.Main outcomes measuresAnnual overall and age-specific and gender-specific incidence and 95% CI, as well as trends in sepsis incidence and mortality, were estimated. Comorbidities, length of hospital stay and outcomes were described.ResultsThe sex-standardised and age-standardised incidence per 100 000 (95% CI) increased from 357 (356.0 to 359.0) in 2015 to 403 (401.9 to 405.0) in 2019 and remained higher for males compared with females. Children under 1 year and patients over 75 years consistently had the highest incidence. The most common comorbidities were cancer and chronic heart failure. The median hospital length of stay was 12 days. Most patients came from home, but only half returned home after their hospital stay and approximately 15% were discharged to long-term care. In-hospital mortality was about 25% and declined along the study period.ConclusionsMedico-administrative databases can be used to provide nationwide estimates of the in-hospital burden of bacterial sepsis. The results confirm the high burden of sepsis in France. These data should be complemented by estimating the additional burden associated with fungal and viral infections during the COVID-19 pandemic.

Trends in mortality after a sepsis hospitalization: A nationwide prospective registry study from 2008-2021

“…Further, we found that implicit sepsis patients had the same risk as explicit sepsis patients. This is in contrast to a nationwide study based on ICD-10 codes, and a study investigating mortality trends comparing clinical versus claims data, and found that explicit sepsis had a higher in-hospital mortality 31,27 . For comparison, some of the diverging results can be explained by ICD-10 code selection and search strategies, where they included other combinations of ICD-10 codes to identify implicit sepsis and searched in a lower number of secondary diagnoses to combine infection and organ dysfunction.…”

“…The meta-analysis by Stevenssons and colleagues (2014) found an annual decrease of 3.0% in 28-day mortality 28 , while the meta-analysis by Luhr et al (2019) found an annual decrease of 0.42% in 28-day mortality, which was more pronounced in studies with a mean age ≥65 years. Our approach of using administrative databases to calculate mortality trends in sepsis patients is common 2,5,7,30,31 , but not without controversy 10,32 . The decline in mortality rates are often attributed to the Will-Rogers phenomenon, which explains reduced mortality as a consequence of including a larger proportion of less severely ill sepsis patients due to increased sepsis awareness 33 .…”

“…Surprisingly, only 8.5% of the sepsis patients received ICU treatment. In comparison, a recent French nationwide study found that over 50% of sepsis patients received ICU treatment 31 . Some of the discrepancies between studies can be explained by the relatively few intensive care beds in Norway compared to France 39 .…”

One-year hospital readmission for recurrent sepsis: associated risk factors and impact on 1-year mortality—a French nationwide study

“…The study consisted of a secondary data analysis of a cohort of all patients with bacterial infections and registered in the anonymized French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d'Information: PMSI) and outpatient health care consumption (Données de Consommation Inter-Régimes: DCIR) issued from the French health care database (Système National des Données de Santé: SNDS) (see Additional file 1 : eMethods) [ 27 , 28 ]. Therefore, only cases of sepsis of presumed bacterial etiology (referred to herein as sepsis) were considered.…”

“…The selection in the French medico-administrative database was based on a list of ICD-10 codes, organ dysfunction and ICU admission (see Additional file 1 : eMethods and eTable 1). More details about the selection can be found in our previous study [ 27 ]. Only hospital stays in an acute-care facility (MSO: medicine surgery and obstetrics) were considered.…”