Epidemiology of sepsis and septic shock in intensive care units between sepsis-2 and sepsis-3 populations: sepsis prognostication in intensive care unit and emergency room (SPICE-ICU)
Year: 2020
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Diagnosing sepsis remains difficult because it is not a single disease but a syndrome with various pathogen- and host factor-associated symptoms. Sepsis-3 was established to improve risk stratification among patients with infection based on organ failures, but it has been still controversial compared with previous definitions. Therefore, we aimed to describe characteristics of patients who met sepsis-2 (severe sepsis) and sepsis-3 definitions. METHODS: This was a multicenter, prospective cohort study conducted by 22 intensive care units (ICUs) in Japan. Adult patients (≥ 16 years) with newly suspected infection from December 2017 to May 2018 were included. Those without infection at final diagnosis were excluded. Patient's characteristics and outcomes were described according to whether they met each definition or not. RESULTS: In total, 618 patients with suspected infection were admitted to 22 ICUs during the study, of whom 530 (85.8%) met the sepsis-2 definition and 569 (92.1%) met the sepsis-3 definition. The two groups comprised different individuals, and 501 (81.1%) patients met both definitions. In-hospital mortality of study population was 19.1%. In-hospital mortality among patients with sepsis-2 and sepsis-3 patients was comparable (21.7% and 19.8%, respectively). Patients exclusively identified with sepsis-2 or sepsis-3 had a lower mortality (17.2% vs. 4.4%, respectively). No patients died if they did not meet any definitions. Patients who met sepsis-3 shock definition had higher in-hospital mortality than those who met sepsis-2 shock definition. CONCLUSIONS: Most patients with infection admitted to ICU meet sepsis-2 and sepsis-3 criteria. However, in-hospital mortality did not occur if patients did not meet any criteria. Better criteria might be developed by better selection and combination of elements in both definitions. TRIAL REGISTRATION: UMIN000027452.
Source: Journal of Intensive Care
Authors: Toshikazu Abe, Kazuma Yamakawa, Hiroshi Ogura, Shigeki Kushimoto, Daizoh Saitoh, Seitaro Fujishima, Yasuhiro Otomo, Joji Kotani, Yutaka Umemura, Yuichiro Sakamoto, Junichi Sasaki, Yasukazu Shiino, Naoshi Takeyama, Takehiko Tarui, Shin-ichiro Shiraishi, Ryosuke Tsuruta, Taka-aki Nakada, Toru Hifumi, Akiyoshi Hagiwara, Masashi Ueyama, Norio Yamashita, Tomohiko Masuno, Hiroto Ikeda, Akira Komori, Hiroki Iriyama, Satoshi Gando, for the JAAM SPICE Study Group
Institutions: University of Tsukuba, Tsukuba Memorial Hospital, Research and Development Center for Health Services, University of Tsukuba, Osaka Prefectural Medical Center, The University of Osaka, Tohoku University, Tohoku University Hospital, National Defense Medical College Hospital, National Defense Medical College, Keio University, Tokyo Medical and Dental University, Kobe University, Saga University, Keio University Hospital, Kawasaki Medical School, Aichi Medical University, Aichi Medical University Hospital, Kyorin University, Aidu Chuo Hospital, Yamaguchi University Hospital, Chiba University, St. Luke's International Hospital, Japan Community Healthcare Organization, Chukyo Hospital, Kurume University Hospital, Kurume University Medical Center, Nippon Medical School Hospital, Nippon Medical School, Teikyo University Hospital, Teikyo University, Juntendo University, Hokkaido University, Sapporo Higashi Tokushukai Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid:
Awards: Clinical scenario of sepsis: reclassification of severe infection syndrome with organ failures, Histone- and NETs-targeted elucidation of pathomechanisms and therapeutics of trauma-induced coagulopathy, Participation of innate-immune inflammation and coagulofibrinolytic responses to the organ dysfunction in post cardiac arrest syndrome
OpenAlex ID: W3040107171