Acute Crit Care.  2019 Aug;34(3):179-191. 10.4266/acc.2019.00514.

Characteristics, management and clinical outcomes of patients with sepsis: a multicenter cohort study in Korea

• Jeon K
• Na SJ
• Oh DK
• Park S
• Choi EY
• Kim SC
• Seong GM
• Heo J
• Chang Y
• Kwack WG
• Kang BJ
• Choi WI
• Kim KC
• Park SY
• Kwak SH
• Shin YM
• Lee HB
• Park SH
• Cho JH
• Kim B
• Lim CM
• Korean Sepsis Alliance (KSA) study group

• KMID: 2457676
• DOI: http://doi.org/10.4266/acc.2019.00514

Abstract

BACKGROUND
Mortality rates associated with sepsis have increased progressively in Korea, but domestic epidemiologic data remain limited. The objective of this study was to investigate the characteristics, management and clinical outcomes of sepsis patients in Korea.
METHODS
This study is a multicenter retrospective cohort study. A total of 64,021 adult patients who visited an emergency department (ED) within one of the 19 participating hospitals during a 1-month period were screened for eligibility. Among these, patients diagnosed with sepsis based on the third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were included in the study.
RESULTS
Using the Sepsis-3 criteria, 977 sepsis patients were identified, among which 36.5% presented with septic shock. The respiratory system (61.8%) was the most common site of infection. The pathogen involved was identified in 444 patients (45.5%) and multi-drug resistance (MDR) pathogens were isolated in 171 patients. Empiric antibiotic therapy was appropriate in 68.6% of patients, but the appropriateness was significantly reduced in infections associated with MDR pathogens as compared with non-MDR pathogens (58.8% vs. 76.0%, P<0.001). Hospital mortality was 43.2% and 18.5% in sepsis patients with and without shock, respectively. Of the 703 patients who survived to discharge, 61.5% were discharged to home and 38.6% were transferred to other hospitals or facilities.
CONCLUSIONS
This study found the prevalence of sepsis in adult patients visiting an ED in Korea was 1.5% (15.2/1,000 patients). Patients with sepsis, especially septic shock, had a high mortality and were often referred to step-down centers after acute and critical care.

Keyword

epidemiology; Korea; mortality; prevalence; sepsis; septic shock

MeSH Terms

Adult
Cohort Studies*
Consensus
Critical Care
Drug Resistance, Multiple
Emergency Service, Hospital
Epidemiology
Hospital Mortality
Humans
Korea*
Mortality
Prevalence
Respiratory System
Retrospective Studies
Sepsis*
Shock
Shock, Septic

Figure

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  Figure 1. Appropriateness of initial antibiotics. (A) Comparison of multi-drug resistance (MDR) and non-MDR pathogen. (B) Comparison among specific MDR pathogens.

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  Figure 2. One-hour Surviving Sepsis Campaign bundle compliance between sepsis and septic shock. IV: intravenous.

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