Epidemiology and prognostic factors in severe sepsis/septic shock. Evolution over six years

Abstract

Objective: To determine the clinical characteristics and prognostic factors of patients with severe sepsis/septic shock admitted to the Intensive Care Unit of Donostia University Hospital (Guipuzcoa, Spain).

Design: A prospective, observational study was carried out during a consecutive 6-year period (1st February 2008-31st December 2013).

Setting: The Intensive Care Unit of Donostia University Hospital, the only third level hospital in the province of Guipuzcoa, with a recruitment population of 700,000 inhabitants.

Results: Number of patients with severe sepsis/septic shock has progressively increased over the last years to reach 1,136 patients, yet significant changes in age, sex, Acute Physiology and Chronic Health Evaluation II, procalcitonin and lactate values could not be observed. In the last years, admission rate from Emergency Department has increased in comparison to admissions from hospitalization ward, with a higher incidence of urological sepsis. Hemodynamic and renal dysfunctions have been the most prevalent disorders, respiratory involvement and thrombocytopenia have gone down while coagulopathy has increased significantly. Mortality has decreased significantly. We have performed a multivariate analysis of the early prognostic factors. Type, origin, sepsis etiology, lactate and the presence of organ dysfunction -except for hyperbilirubinemia and hypotension- were the most important mortality factors.

Conclusions: Severe sepsis and septic shock result in growing ICU admissions. Although clinical features have barely changed over the last years, we have observed a decrease in mortality. We find important knowing these early prognostic factors to improve the management of these patients.

Keywords: Early prognostic factors; Epidemiology; Epidemiología; Factores pronósticos precoces; Mortalidad; Mortality; Sepsis grave; Septic shock; Severe sepsis; Shock séptico.