Epidemiological Study of Sepsis in China: Protocol of a Cross-sectional Survey

Yi Yang, Jian-Feng Xie, Kai-Jiang Yu, Chen Yao, Jian-Guo Li, Xiang-Dong Guan, Jing Yan, Xiao-Chun Ma, Yan Kang, Cong-Shan Yang, Xiao-Qing Yao, Hong-Cai Shang, Hai-Bo Qiu, for CHESS Study Investigators, Yi Yang, Jian-Feng Xie, Kai-Jiang Yu, Chen Yao, Jian-Guo Li, Xiang-Dong Guan, Jing Yan, Xiao-Chun Ma, Yan Kang, Cong-Shan Yang, Xiao-Qing Yao, Hong-Cai Shang, Hai-Bo Qiu, for CHESS Study Investigators

Abstract

Background: Sepsis is the leading cause of death among critically ill patients. Herein, we conducted a national survey to provide data on epidemiology and treatment of sepsis in the clinical practice in China, which has no detailed epidemiological data available on sepsis.

Methods: This was a prospective cross-sectional survey from December 1, 2015 to January 31, 2016 in all provinces/municipalities of the mainland of China. The primary outcome of this study was the incidence of sepsis, and the secondary outcome was its etiology in China. Patients with sepsis admitted to the Intensive Care Units were included in this study. The demographic, physiological, bacteriological, and therapeutic data of these patients were recorded. The incidence of sepsis was estimated using the data from the sixth census in China, reported by the Chinese National Health and Family Planning Commission and the National Bureau of Statistics as the standard population. The independent risk factors for increased mortality from sepsis were calculated.

Conclusions: This study indicated the incidence and outcome of sepsis in China. It also showed the most common etiology of different sites and types of infection, which could guide empiric antibiotic therapy. Moreover, it provided information on the independent risk factors for increased mortality due to sepsis. The findings provide evidence to guide clinical management and may help improve the outcome in septic patients.

Trial registration: ClinicalTrials.gov, NCT02448472; https://ichgcp.net/clinical-trials-registry/NCT02448472.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Detailed flowchart of the Chinese Epidemiological Study of Sepsis. ICU: Intensive Care Unit.

References

    1. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:840–51. doi: 10.1056/NEJMra1208623.
    1. Vincent JL, Marshall JC, Namendys-Silva SA, François B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: The intensive care over nations (ICON) audit. Lancet Respir Med. 2014;2:380–6. doi: 10.1016/S2213-2600(14)70061-X.
    1. Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41:1167–74. doi: 10.1097/CCM.0b013e31827c09f8.
    1. Seymour CW, Rea TD, Kahn JM, Walkey AJ, Yealy DM, Angus DC. Severe sepsis in pre-hospital emergency care: Analysis of incidence, care, and outcome. Am J Respir Crit Care Med. 2012;186:1264–71. doi: 10.1164/rccm.201204-0713OC.
    1. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand 2000-2012. JAMA. 2014;311:1308–16. doi: 10.1001/jama.2014.2637.
    1. 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;29:1303–10. doi: 10.1097/00003246-200107000-00002.
    1. Annane D, Aegerter P, Jars-Guincestre MC, Guidet B. CUB-Réa Network. Current epidemiology of septic shock: The CUB-Réa Network. Am J Respir Crit Care Med. 2003;168:165–72. doi: 10.1164/rccm.2201087.
    1. 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;348:1546–54. doi: 10.1056/NEJMoa022139.
    1. Harrison DA, Welch CA, Eddleston JM. The epidemiology of severe sepsis in England, Wales and Northern Ireland 1996 to 2004: Secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database. Crit Care. 2006;10:R42. doi: 10.1186/cc4854.
    1. Blanco J, Muriel-Bombín A, Sagredo V, Taboada F, Gandía F, Tamayo L, et al. Incidence, organ dysfunction and mortality in severe sepsis: A Spanish multicentre study. Crit Care. 2008;12:R158. doi: 10.1186/cc7157.
    1. Rodríguez F, Barrera L, De La Rosa G, Dennis R, Dueñas C, Granados M, et al. The epidemiology of sepsis in Colombia: A prospective multicenter cohort study in ten university hospitals. Crit Care Med. 2011;39:1675–82. doi: 10.1097/CCM.0b013e318218a35e.
    1. Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med. 2004;30:589–96. doi: 10.1007/s00134-004-2157-0.
    1. Adrie C, Alberti C, Chaix-Couturier C, Azoulay E, De Lassence A, Cohen Y, et al. Epidemiology and economic evaluation of severe sepsis in France: Age, severity, infection site, and place of acquisition (community, hospital, or intensive care unit) as determinants of workload and cost. J Crit Care. 2005;20:46–58. doi: 10.1016/j.jcrc.2004.10.005.
    1. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003. Crit Care Med. 2007;35:1244–50. doi: 10.1097/01.CCM.0000261890.41311.E9.
    1. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med. 2016;193:259–72. doi: 10.1164/rccm.201504-0781OC.
    1. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323–9. doi: 10.1001/jama.2009.1754.
    1. Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X, et al. Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS One. 2014;9:e107181. doi: 10.1371/journal.pone.0142287.
    1. Cheng B, Xie G, Yao S, Wu X, Guo Q, Gu M, et al. Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China. Crit Care Med. 2007;35:2538–46. doi: 10.1097/01.CCM.0000284492.30800.00.
    1. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–74. doi: 10.1097/00003246-199206000-00025.
    1. Calandra T, Cohen J. International Sepsis Forum Definition of Infection in the ICU Consensus Conference. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005;33:1538–48. doi: 10.1097/01.CCM.0000168253.91200.83.
    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228. doi: 10.1007/s00134-012-2769-8.
    1. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372:1629–38. doi: 10.1056/NEJMoa1415236.
    1. Abraham E. New definitions for sepsis and septic shock: Continuing evolution but with much still to be done. JAMA. 2016;315:757–9. doi: 10.1001/jama.2016.0290.
    1. Vincent JL, Martin GS, Levy MM. qSOFA does not replace SIRS in the definition of sepsis. Crit Care. 2016;20:210. doi: 10.1186/s13054-016-1389-z.
    1. Simpson SQ. New sepsis criteria: A change we should not make. Chest. 2016;149:1117–8. doi: 10.1016/j.chest.2016.02.653.
    1. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA. 1995;273:117–23. doi: 10.1001/jama.273.2.117.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir