Mortality of severe septic patients between physician's high and low care volumes

Abstract

Background: Patients with severe sepsis frequently require intensive care unit (ICU) admission and different ICU care models may influence their outcomes. The mortality of severe septic patients between physician's high and low care volume remains unclear.

Methods: We analyzed the data from a three-year prospective observation study, which was performed in an adult medical ICU of Chung Gung Memorial Hospital, Keelung. The data included initial bundle therapies based on the Surviving Sepsis Campaign (SSC) guidelines for patients with severe sepsis.

Results: Clinical data of total 484 patients with severe sepsis were recorded. Cox regression model showed that physician's care volume was an independent factor for lowering mortality in ICU patients with severe sepsis (hazard ratio 0.708; 95% confidence interval 0.514-0.974; p = 0.034). Patients treated by high care volume physician had four out of nine bundle therapies that were significantly higher in percentage following the SSC guidelines. These four therapies were renal replacement therapy, administration of low-dose steroids for septic shock, prophylaxis of gastro-intestinal bleeding, and control of hyperglycemia.

Conclusion: High care volume physician may decrease mortality in ICU patients with severe sepsis through fitting bundle therapies for sepsis.

Keywords: Intensive care unit; Mortality; Physician's care volume; Severe sepsis.

Fig. 1

The 28-day survival curves of ICU patients with sepsis between high and low care volume of physicians were drawn if other variables were not included in the model. The 28-day survival curve of the low care volume group is lower than that of the high care volume group. Solid and dotted lines represented the survival curve of high and low care volume of physicians, respectively (hazard ratio 0.709; 95% confidence interval 0.511–0.983; p = 0.039).