J Korean Med Sci.  2012 Nov;27(11):1308-1314. 10.3346/jkms.2012.27.11.1308.

Epidemiological and Clinical Characteristics of Community-Acquired Severe Sepsis and Septic Shock: A Prospective Observational Study in 12 University Hospitals in Korea

• Park DW
• Chun BC
• Kim JM
• Sohn JW
• Peck KR
• Kim YS
• Choi YH
• Choi JY
• Kim SI
• Eom JS
• Kim HY
• Song JY
• Song YG
• Choi HJ
• Kim MJ

• KMID: 2157939
• DOI: http://doi.org/10.3346/jkms.2012.27.11.1308

Abstract

A prospective multicenter observational study was performed to investigate the epidemiology and outcomes of community-acquired severe sepsis and septic shock. Subjects included 1,192 adult patients admitted to the 22 participating intensive care units (ICUs) of 12 university hospitals in the Korean Sepsis Registry System from April, 2005 through February, 2009. Male accounted for 656 (55%) patients. Mean age was 65.0 +/- 14.2 yr. Septic shock developed in 740 (62.1%) patients. Bacteremia was present in 422 (35.4%) patients. The 28-day and in-hospital mortality rates were 23.0% and 28.0%, respectively. Men were more likely to have comorbid illnesses and acute organ dysfunctions, and had higher mortality and clinical severity compared to women. While respiratory sources of sepsis were common in men, urinary sources were predominant in women. In the multivariate logistic regression analysis, cancer (odds ratio 1.89; 95% confidence interval 1.13-3.17), urinary tract infection (0.25; 0.13-0.46), APACHE II score (1.05; 1.02-1.09), SOFA score on day 1 (1.13; 1.06-1.21) and metabolic dysfunction (2.24, 1.45-3.45) were independent clinical factors for gender-related in-hospital mortality. This study provided epidemiological and clinical characteristics of community-acquired severe sepsis and septic shock in ICUs in Korea, and demonstrated the impact of clinical factors on gender difference in mortality.

Keyword

Epidemiology; Severe Sepsis; Septic Shock; Mortality; Risk Factor; Gender

MeSH Terms

APACHE
Adult
Aged
Aged, 80 and over
Bacteremia/epidemiology/microbiology
Community-Acquired Infections/epidemiology/microbiology/virology
Comorbidity
Female
Hospital Mortality
Hospitals, University
Humans
Intensive Care Units
Logistic Models
Lung Diseases/epidemiology
Male
Metabolic Diseases/epidemiology
Middle Aged
Neoplasms/epidemiology
Odds Ratio
Prospective Studies
Republic of Korea
Risk Factors
Sepsis/diagnosis/*epidemiology/mortality
Severity of Illness Index
Sex Factors
Shock, Septic/diagnosis/*epidemiology/mortality
Urinary Tract Infections/epidemiology

Figure

• 

  Fig. 1 Gender difference of 28-day and in-hospital mortalities by sex.

Reference

1. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992. 101:1644–1655.

2. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003. 348:1546–1554.

3. Lever A, Mackenzie I. Sepsis: definition, epidemiology, and diagnosis. BMJ. 2007. 335:879–883.

4. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001. 29:1303–1310.

5. Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Régnier B. French ICU Group for Severe Sepsis. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. JAMA. 1995. 274:968–974.

6. Alberti C, Brun-Buisson C, Chevret S, Antonelli M, Goodman SV, Martin C, Moreno R, Ochagavia AR, Palazzo M, Werdan K, et al. Systemic inflammatory response and progression to severe sepsis in critically ill infected patients. Am J Respir Crit Care Med. 2005. 171:461–468.

7. Guidet B, Aegerter P, Gauzit R, Meshaka P, Dreyfuss D. Incidence and impact of organ dysfunctions associated with sepsis. Chest. 2005. 127:942–951.

8. Pittet D, Thievent B, Wenzel RP, Li N, Gurman G, Suter PM. Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients. Intensive Care Med. 1993. 19:265–272.

9. Kim YM, Kwon YS, Kim JS, Kim SY, Jang GS, Lee SW, An Y, Park S, Hwang YI, Jang SH, Jung K, Kim D. Incidence and prognosis of disseminated intravascular coagulation in patients with severe sepsis or septic shock. Korean J Med. 2010. 79:526–535.

10. Yoon YK, Kim MJ, Park DW, Kwon SS, Chun BC, Cheong HJ, Choi YH, Kim HY, Eom JS, Kim SI, et al. Prognostic factors of community-acquired bacteremic patients with severe sepsis: a prospective, observational study. Infect Chemother. 2012. 44:168–174.

11. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988. 16:128–140.

12. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002. 137:791–797.

13. Munford RS. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Severe sepsis and septic shock. Harrison's Principles of Internal Medicine. 2005. 16th ed. New York McGraw-Hill companies, Inc.;1606–1612.

14. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992. 45:613–619.

15. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985. 13:818–829.

16. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001. 286:1754–1758.

17. Australasian resuscitation of sepsis evaluation. Australia and New Zealand Intensive Care Society Adult Patient Database Management Committee. The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand. Crit Care Resusc. 2007. 9:8–18.

18. Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K. Epidemiology of severe sepsis occurring in the first 24 hr in intensive care units in England, Wales, and Northern Ireland. Crit Care Med. 2003. 31:2332–2338.

19. Brun-Buisson C, Meshaka P, Pinton P, Vallet B. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 2004. 30:580–588.

20. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006. 34:344–353.

21. Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, Parsonnet J, Panzer R, Orav EJ, Snydman DR, et al. Epidemiology of sepsis syndrome in 8 academic medical centers. JAMA. 1997. 278:234–240.

22. Esper AM, Martin GS. The impact of comorbid [corrected] conditions on critical illness. Crit Care Med. 2011. 39:2728–2735.

23. Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS. The role of infection and comorbidity: factors that influence disparities in sepsis. Crit Care Med. 2006. 34:2576–2582.

24. Crabtree TD, Pelletier SJ, Gleason TG, Pruett TL, Sawyer RG. Gender-dependent differences in outcome after the treatment of infection in hospitalized patients. JAMA. 1999. 282:2143–2148.

25. Melamed A, Sorvillo FJ. The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care. 2009. 13:R28.

26. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations. Crit Care Med. 2005. 33:2555–2562.

27. Pietropaoli AP, Glance LG, Oakes D, Fisher SG. Gender differences in mortality in patients with severe sepsis or septic shock. Gend Med. 2010. 7:422–437.