Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 1;51(9):1138-1147.
doi: 10.1097/CCM.0000000000005886. Epub 2023 Apr 28.

Association Between Levels of Intensive Care and In-Hospital Mortality in Patients Hospitalized for Sepsis Stratified by Sequential Organ Failure Assessment Scores

Hiroyuki Ohbe  1 , Yusuke Sasabuchi  2 , Kent Doi  3 , Hiroki Matsui  1 , Hideo Yasunaga  1
Affiliations

Association Between Levels of Intensive Care and In-Hospital Mortality in Patients Hospitalized for Sepsis Stratified by Sequential Organ Failure Assessment Scores

Hiroyuki Ohbe et al. Crit Care Med. .

Abstract

Objectives: To assess the association between levels of intensive care and in-hospital mortality in patients hospitalized for sepsis, stratified by Sequential Organ Failure Assessment (SOFA) score at admission.

Design: A nationwide, propensity score-matched, retrospective cohort study.

Setting: A Japanese national inpatient database with data on 70-75% of all ICU and high-dependency care unit (HDU) beds in Japan.

Patients: Adult patients hospitalized for sepsis with SOFA scores greater than or equal to 2 on their day of admission between April 1, 2018, and March 31, 2021, were recruited. Propensity score matching was performed to compare in-hospital mortality, and patients were stratified into 10 groups according to SOFA scores.

Interventions: Two exposure and control groups according to treatment unit on day of admission: 1) ICU + HDU versus general ward and 2) ICU versus HDU.

Measurements and main results: Of 97,070 patients, 19,770 (20.4%), 23,066 (23.8%), and 54,234 (55.9%) were treated in ICU, HDU, and general ward, respectively. After propensity score matching, the ICU + HDU group had significantly lower in-hospital mortality than the general ward group, among cohorts with SOFA scores greater than or equal to 6. There were no significant differences in in-hospital mortality among cohorts with SOFA scores 3-5. The ICU + HDU group had significantly higher in-hospital mortality than the general ward among cohorts with SOFA scores of 2. The ICU group had lower in-hospital mortality than the HDU group among cohorts with SOFA scores greater than or equal to 12. There were no significant differences in in-hospital mortality among cohorts with SOFA scores 5-11. The ICU group had significantly higher in-hospital mortality than the general ward group among cohorts with SOFA scores less than or equal to 4.

Conclusions: Patients hospitalized for sepsis with SOFA scores greater than or equal to 6 in the ICU or HDU had lower in-hospital mortality than those in the general ward, as did those with SOFA scores greater than or equal to 12 in the ICU versus HDU.

PubMed Disclaimer

Conflict of interest statement

Dr. Yasunaga’s institution received funding from the Ministry of Health, Labour and Welfare, Japan and the Ministry of Education, Culture, Sports, Science and Technology, Japan. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

  • Does Critical Care Really Make A Difference?
    Higgins TL. Higgins TL. Crit Care Med. 2023 Sep 1;51(9):1258-1260. doi: 10.1097/CCM.0000000000005903. Epub 2023 Aug 17. Crit Care Med. 2023. PMID: 37589516 No abstract available.
  • Time to Reexamine the Definition of Sepsis?
    Shime N, Inagawa T, MacLaren G. Shime N, et al. Crit Care Med. 2024 Feb 1;52(2):e107-e108. doi: 10.1097/CCM.0000000000006085. Epub 2024 Jan 19. Crit Care Med. 2024. PMID: 38240523 No abstract available.

References

    1. Singer M, Deutschman CS, Seymour CW, et al.: The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315:801–810
    1. Rudd KE, Johnson SC, Agesa KM, et al.: Global, regional, and national sepsis incidence and mortality, 1990-2017: Analysis for the Global Burden of Disease Study. Lancet. 2020; 395:200–211
    1. Sakr Y, Jaschinski U, Wittebole X, et al.; ICON Investigators: Sepsis in intensive care unit patients: Worldwide data from the intensive care over nations audit. Open Forum Infect Dis. 2018; 5:ofy313
    1. Fleischmann-Struzek C, Mellhammar L, Rose N, et al.: Incidence and mortality of hospital- and ICU-treated sepsis: Results from an updated and expanded systematic review and meta-analysis. Intensive Care Med. 2020; 46:1552–1562
    1. Rudd KE, Kissoon N, Limmathurotsakul D, et al.: The global burden of sepsis: Barriers and potential solutions. Crit Care. 2018; 22:232

Publication types