Sepsis and septic shock in France: incidences, outcomes and costs of care

Abstract

Background: Sepsis is one of the leading causes of death worldwide. The associated incidence, mortality and trends do not differ greatly between documented reports. The purpose of this study was to provide an in-depth description of patients with sepsis and septic shock hospitalized in France from 2010 to 2015 and to explore the temporal trends of their clinical characteristics, costs and outcomes.

Methods: Retrospective cohort study of the French hospital administrative database in which organ failure therapies and severity scores are systematically registered. All patients admitted between 2010 and 2015 for sepsis and septic shock as defined by an ICD-10 code for infection, and for organ failure or the use of organ failure supplementation were included. Incidence, outcomes and trends were analyzed. Subgroup analyses based on several coding strategies and adjusted for severity scores were performed.

Results: A total of 737,147 patients with sepsis and 492,902 patients with septic shock were included. From 2010 to 2015, the incidence of sepsis and septic shock increased, respectively, from 206 to 243 and from 135 to 171 cases per 100,000 population. Case fatality remained at 34% for sepsis, but decreased from 46 to 44% for septic shock. Median hospital stay costs amounted to €11,400 (IQR: 5036; 24,364) for patients with sepsis and €16,439 (IQR: 7339; 29,360) for patients with septic shock. After adjustment for case-mix and illness severity, the risk of death was stable for sepsis (0.08% [- 0.04; 0.20] per year), but decreased for sepsis patients admitted to the intensive care unit and for cases of septic shock (- 0.33%[ - 0.40; - 0.27] per year).

Conclusions: Sepsis is common, frequently fatal and expensive to treat. Its incidence has increased. Case fatality has decreased in most severely affected patients, owing partly to general improvements in care.

Keywords: Epidemiology; Secular trends; Sepsis; Septic shock.

Fig. 1

ICD-10: International Statistical Classification of Diseases, 10th Edition. CCAM: “classification commune des actes médicaux”. Implicit definition of sepsis: a code for infection using ICD-10 and a code for organ failure and/or a procedure code for the use of organ failure supplementation (using ICD-10 and/or CCAM). Explicit definition of sepsis: ICD-10 codes including R651 or R572 or R578 or R579. Implicit definition of septic shock: a code for infection using ICD-10 and a code for shock and/or a procedure code for the use of vasopressor (using ICD-10 and/or CCAM). Explicit definition of septic shock: ICD-10 codes including R572 or R578 or R579

Fig. 2.

Incidence, mortality, case fatality from 2010 to 2015 in the whole cohort of patients with sepsis (a) and adjusted relative risk of hospital death rate from 2010 to 2015, in the whole cohort of patients with sepsis (b). The adjusted relative risk of hospital death was based on the adjusted odd ratio of death obtained by a multivariate hierarchical logistic regression analysis with a random center effect taking into account all the associated factors of hospital death (Additional file 1: Table S11)

Fig. 3.

Incidence, mortality, case fatality from 2010 to 2015 in the whole cohort of patients with septic shock (a) and adjusted relative risk of hospital death rate from 2010 to 2015, in the whole cohort of patients with septic shock (b). The adjusted relative risk of hospital death was based on the adjusted odd ratio of death obtained by a multivariate hierarchical logistic regression analysis with a random center effect taking into account all the associated factors of hospital death (Additional file 1: Table S11)