Epidemiology and Outcome of Severe Sepsis and Septic Shock in Intensive Care Units in Mainland China

et al. (2014) Epidemiology and Outcome of Severe Sepsis and Septic Shock in Intensive Care Units in Mainland China. PLoS ONE 9(9): e107181. doi:10.1371/journal.pone.0107181 Epidemiology and Outcome of Severe Sepsis and Septic Shock in Intensive Care Units in Mainland China Jianfang Zhou 0 Chuanyun Qian 0 Mingyan Zhao 0 Xiangyou Yu 0 Yan Kang 0 Xiaochun Ma 0 Yuhang Ai 0 Yuan Xu 0 Dexin Liu 0 Youzhong An 0 Dawei Wu 0 Renhua Sun 0 Shusheng Li 0 Zhenjie Hu 0 Xiangyuan Cao 0 Fachun Zhou 0 Li Jiang 0 Jiandong Lin 0 Enqiang Mao 0 Tiehe Qin 0 Zhenyang He 0 Lihua Zhou 0 Bin Du 0 for the China Critical Care Clinical Trials Group (CCCCTG) 0 Jorge I. F. Salluh, D'or Institute of Research and Education, Brazil 0 1 Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences , Beijing , China , 2 Department of Emergency Medicine and Medical ICU, The First Affiliated Hospital of Kunming Medical University , Kunming , China , 3 Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University , Harbin , China , 4 Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University , Urumqi , China , 5 Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China , 6 Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University , Shenyang , China , 7 Department of Critical Care Medicine, Xiangya Hospital, Central South University , Changsha , China , 8 Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University , Beijing , China , 9 Department of Critical Care Medicine, The Second Hospital of Jilin University , Changchun , China , 10 Department of Critical Care Medicine, Peking University People's Hospital , Beijing , China , 11 Department of Critical Care Medicine, Qilu Hospital of Shandong University , Jinan , China , 12 Department of Critical Care Medicine, Zhejiang Provincial People's Hospital , Hangzhou , China , 13 Department of Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China , 14 Department of Critical Care Medicine, Hebei Medical University Fourth Hospital , Shijiazhuang , China , 15 Department of Critical Care Medicine, General Hospital of Ningxia Medical University , Yinchuan , China , 16 Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University , Chongqing , China , 17 Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University , Beijing , China , 18 Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China, 19 Emergency ICU , Ruijin Hospital, Shanghai Jiao Tong University , Shanghai , China , 20 Department of Critical Care Medicine, Guangdong General Hospital , Guangzhou , China , 21 Department of Critical Care Medicine, Hainan Provincial People's Hospital , Haikou , China , 22 Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University , Huhhot , China Introduction: Information about sepsis in mainland China remains scarce and incomplete. The purpose of this study was to describe the epidemiology and outcome of severe sepsis and septic shock in mixed ICU in mainland China, as well as the independent predictors of mortality. Methods: We performed a 2-month prospective, observational cohort study in 22 closed multi-disciplinary intensive care units (ICUs). All admissions into those ICUs during the study period were screened and patients with severe sepsis or septic shock were included. Results: A total of 484 patients, 37.3 per 100 ICU admissions were diagnosed with severe sepsis (n = 365) or septic shock (n = 119) according to clinical criteria and included into this study. The most frequent sites of infection were the lung and abdomen. The overall ICU and hospital mortality rates were 28.7% (n = 139) and 33.5% (n = 162), respectively. In multivariate analyses, APACHE II score (odds ratio[OR], 1.068; 95% confidential interval[CI], 1.027-1.109), presence of ARDS (OR, 2.676; 95%CI, 1.691-4.235), bloodstream infection (OR, 2.520; 95%CI, 1.142-5.564) and comorbidity of cancer (OR, 2.246; 95%CI, 1.141-4.420) were significantly associated with mortality. Conclusions: Our results indicated that severe sepsis and septic shock were common complications in ICU patients and with high mortality in China, and can be of help to know more about severe sepsis and septic shock in China and to improve characterization and risk stratification in these patients. - Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files. Funding: This research was supported in part, by the Capital Clinical Application Research grant (Number: Z131107002213112) from the Science and Technology Commission of Beijing, and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Severe sepsis and septic shock are among the main factors contributing to mortality in intensive care units (ICUs), and exhibit a significant disease burden and negative economic impact [13]. The incidence of sepsis varies among different racial and ethnic groups [47]. Between 6 and 54% of patients admitted to ICUs have severe sepsis [2,3,6,810], and the mortality rate for these patients varies from 20 to 60% [6,1012], which will increase stepwise with increasing disease severity [13]. Although the mortality rate may have decreased in recent years [5,7], the incidence of severe sepsis and septic shock is increasing, so that overall deaths are increasing [2,4,7]. Even death has been avoided, the patient who survives sepsis would have a significantly compromised long-term health-related quality of life than general population [1,14]. There have been a number of studies describing the epidemiology, risk factor and outcome of severe sepsis and septic shock in different countries [2,4,7,10,11]. Yet, information about sepsis in mainland China remains scarce and incomplete. Cheng et al [3] have described the epidemiology of severe sepsis in surgical ICUs, but data concerning the epidemiology of severe sepsis/septic shock in mixed ICUs are limited. So the China Critical Care Clinical Trials Group (CCCCTG) conducted an inception cohort study to investigate the epidemiology and outcome of severe sepsis and septic shock in mixed ICUs in China. Patients and Methods Study development This was a secondary analysis of a prospective cohort study aiming to describe the demographics, case mix, interventions, and clinical outcome of critically ill patients admitted to ICUs in Mainland China and performed from 1 (...truncated)