Epidemiology of sepsis in Catalonia: analysis of incidence and outcomes in a European setting

Juan Carlos Yébenes, Juan Carlos Ruiz-Rodriguez, Ricard Ferrer, Montserrat Clèries, Anna Bosch, Carol Lorencio, Alejandro Rodriguez, Xavier Nuvials, Ignacio Martin-Loeches, Antoni Artigas, SOCMIC (Catalonian Critical Care Society) Sepsis Working Group, Abdo Taché, Antoni Margarit, Assumpta Ricart, Adolf Ruiz-Sanmartin, Begoña Balsera, Berta Cisteró, Candelària de Haro, Concepció Rovira, Eva Torrents, Francisco Álvarez-Lerma, Herbert Baquerizo, Joan Balcells, José L Echarte, José Luna, Josep M Sirvent, Juan Méndez, Lluís Zapata, Lluïsa Bordejé, Lourdes Jiménez, Maite Martínez-Izquierdo, María L Martínez, María P Gracia-Arnillas, Mercedes Palomar, Miguel Sánchez, Pablo Pujol, Pau Garro, Pau Torrabadella, Paula Vera, Roger Bisbal, Ruth Hernández, Teresa M Tomasa, Víctor Pérez-Claveria, Juan Carlos Yébenes, Juan Carlos Ruiz-Rodriguez, Ricard Ferrer, Montserrat Clèries, Anna Bosch, Carol Lorencio, Alejandro Rodriguez, Xavier Nuvials, Ignacio Martin-Loeches, Antoni Artigas, SOCMIC (Catalonian Critical Care Society) Sepsis Working Group, Abdo Taché, Antoni Margarit, Assumpta Ricart, Adolf Ruiz-Sanmartin, Begoña Balsera, Berta Cisteró, Candelària de Haro, Concepció Rovira, Eva Torrents, Francisco Álvarez-Lerma, Herbert Baquerizo, Joan Balcells, José L Echarte, José Luna, Josep M Sirvent, Juan Méndez, Lluís Zapata, Lluïsa Bordejé, Lourdes Jiménez, Maite Martínez-Izquierdo, María L Martínez, María P Gracia-Arnillas, Mercedes Palomar, Miguel Sánchez, Pablo Pujol, Pau Garro, Pau Torrabadella, Paula Vera, Roger Bisbal, Ruth Hernández, Teresa M Tomasa, Víctor Pérez-Claveria

Abstract

Background: Up-to-date identification of local trends in sepsis incidence and outcomes is of considerable public health importance. The aim of our study was to estimate annual incidence rates and in-hospital mortality trends for hospitalized patients with sepsis in a European setting, while avoiding selection bias in relation to different complexity hospitals.

Methods: A large retrospective analysis of a 5-year period (2008-2012) was conducted of hospital discharge records obtained from the Catalan Health System (CatSalut) Minimum Basic Data Set for Acute-Care Hospitals (a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia). Patients hospitalized with sepsis were detected on the basis of ICD-9-CM codes used to identify acute organ dysfunction and infectious processes.

Results: Of 4,761,726 discharges from all acute-care hospitals in Catalonia, 82,300 cases (1.72%) had sepsis diagnoses. Annual incidence was 212.7 per 100,000 inhabitants/year, rising from 167.2 in 2008 to 261.8 in 2012. Length of hospital stay fell from 18.4 to 15.3 days (p < .00001), representing a relative reduction of 17%. Hospital mortality fell from 23.7 to 19.7% (p < .0001), representing a relative reduction of 16.9%. These differences were confirmed in the multivariate analysis (adjusted for age group, sex, comorbidities, ICU admission, emergency admission, organ dysfunction, number of organ failures, sepsis source and bacteraemia).

Conclusions: Sepsis incidence has risen in recent years, whereas mortality has fallen. Our findings confirm reports for other parts of the world, in the context of scarce administrative data on sepsis in Europe.

Keywords: Epidemiology; Mortality; Sepsis; Septic shock.

Figures

Fig. 1
Fig. 1
Number of cases, mortality rates and hospital incidence rates for sepsis in Catalonia (2008–2012). Incidence of sepsis increased from 12,809 cases to 20,228 cases in the 5-year study period (mean 16,460 cases per year), representing 1.3 and 2.1% (p < .0001) of hospital admissions and an average yearly increase of 6%. However, hospital mortality decreased from 23.7 to 19.7% (p < .0001) for a yearly relative reduction of 3.4%
Fig. 2
Fig. 2
Age-specific incidence and mortality rates for all cases of severe sepsis by sex in Catalonia (2008–2012). The dark line represents incidence (thicker for men and thinner for women) expressed as a thousand cases per 100,000 inhabitants. Age-adjusted mortality is expressed as the number of deaths with respect to the number of cases grouped according to 5-year age brackets
Fig. 3
Fig. 3
Trends for main characteristics and hospital stay for patients with sepsis in Catalonia (2008–2012)

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Source: PubMed

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