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Clinical Trial
. 2018 Nov 22;22(1):322.
doi: 10.1186/s13054-018-2186-7.

Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study

Toshikazu Abe  1   2 , Hiroshi Ogura  3 , Atsushi Shiraishi  4 , Shigeki Kushimoto  5 , Daizoh Saitoh  6 , Seitaro Fujishima  7 , Toshihiko Mayumi  8 , Yasukazu Shiino  9 , Taka-Aki Nakada  10 , Takehiko Tarui  11 , Toru Hifumi  12 , Yasuhiro Otomo  13 , Kohji Okamoto  14 , Yutaka Umemura  3 , Joji Kotani  15 , Yuichiro Sakamoto  16 , Junichi Sasaki  17 , Shin-Ichiro Shiraishi  18 , Kiyotsugu Takuma  19 , Ryosuke Tsuruta  20 , Akiyoshi Hagiwara  21 , Kazuma Yamakawa  22 , Tomohiko Masuno  23 , Naoshi Takeyama  24 , Norio Yamashita  25 , Hiroto Ikeda  26 , Masashi Ueyama  27 , Satoshi Fujimi  22 , Satoshi Gando  28 ; JAAM FORECAST group
Collaborators, Affiliations
Clinical Trial

Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study

Toshikazu Abe et al. Crit Care. .

Abstract

Background: Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan.

Methods: This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria.

Results: In total, 1184 patients (median age 73 years, interquartile range (IQR) 64-81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6-11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21-26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12-46) days. Approximately 37% of the patients were discharged home after recovery.

Conclusion: Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan.

Trial registration: UMIN-CTR, UMIN000019742 . Registered on 16 November 2015.

Keywords: Bundle; Elderly; Resuscitation; Sepsis.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was reviewed and approved by the ethics committee of all participant institutes in the Japanese Association for Acute Medicine (JAAM) study group, Japan. (IRB number 014–0306 on Hokkaido University, the representative for FORECAST).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Survival probability during the first 80 days for patients with severe sepsis (n = 1043)
See this image and copyright information in PMC

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