Elsevier

Journal of Critical Care

Volume 31, Issue 1, February 2016, Pages 58-62
Journal of Critical Care

Sepsis
Epidemiology of severe sepsis: 2008-2012

https://doi.org/10.1016/j.jcrc.2015.09.034Get rights and content

Abstract

Introduction

Severe sepsis continues to be a significant burden on society.

Methods

Using the International Classification of Diseases, Ninth Revision, Clinical Modification codes, we analyzed the Healthcare Cost and Utilization Project National Inpatient Sample in order to estimate epidemiologic trends of severe sepsis from the years 2008 to 2012. The 2010 US Census, which included 308 745 538 individuals, was used to calculate incidence per 100 000 persons.

Results

There were a total of 6 067 789 discharges for severe sepsis. The annual incidence increased from 346/100 000 to 436/100 000 persons (P < .05). Individuals with 3 or greater organ system failures increased from 31.6% to 35.5% (P < .05), and they accounted for 57.2% to 66.7% of the total number of deaths. Overall mortality decreased from 22.2% to 17.3% (P < .05). Length of stay decreased from 9 to 7 days (P < .05). Those discharged to home with and without home-health increased (23%-27%; P < .05), but those discharged to skilled nursing facilities remained the same (35%).

Conclusions

The incidence of severe sepsis continues to increase, whereas mortality decreases. However, one third of patients (those with ≥ 3 organ system failures) account for two thirds of the total number of deaths. More people are discharged home, whereas stable numbers go to facilities.

Introduction

Severe sepsis continues to be a significant burden on society, recently cited as being the leading cause of in-hospital death in the United States [1] and consuming almost half of intensive care unit resources [2]. It continues to have a persistent increase in incidence, and in-hospital mortality is currently estimated to be 20% to 45% [3]. Although there have been landmark changes in the way severe sepsis is understood [4], debate continues about the best way to treat it [4], [5], [6], [7], [8], [9], [10], [11], [12].

Within the realm of understanding the significance of severe sepsis on a broad level, a number of epidemiologic studies have been done using retrospective databases. These studies span a period of approximately 30 years (1979-2009) [1], [2], [13], [14], [15], [16], [17]. Throughout this period, specific trends have emerged. There has been an increasing incidence of severe sepsis and an increasing number of total deaths, but a decrease in overall in-hospital case mortality. Studies also report an increase in the number of organ systems (OSs) failing, supporting increased severity of illness. However, there has been a decrease in length of in-hospital stay, along with a decrease in the number of people discharged to home, coupled with an increase in the number of people discharged to facilities, such as skilled nursing facilities (SNFs). As demographics have been analyzed, there has been an increase in the age at which severe sepsis occurs, as well as a slight predominance in male patients.

The goal of this study was to evaluate the epidemiologic trends of severe sepsis from the years 2008 to 2012 using the Healthcare Cost and Utilization Project National (Nationwide) Inpatient Sample (HCUP NIS) database. As Kumar and colleagues [15] note, it is important to understand the epidemiologic trends of sepsis, given its clinical significance, in order to make appropriate resource allocation decisions and judgments on the efficacy of the prevailing treatment paradigm.

Section snippets

Data source

The NIS is the largest publicly available all-payer inpatient health care database in the United States. The NIS is part of the HCUP, sponsored by the Agency for Healthcare Research and Quality. The HCUP is a collection of health care databases that create a national-level resource of longitudinal hospital care data in the United States. At present, 44 states are included in the NIS, which contains data from more than 7 million hospital stays from about 1000 hospitals each year [18].

For each

Incidence and demographics

There were a total of 6 067 789 discharges for severe sepsis from 2008 to 2012, and the 2010 US census included 308 745 538 individuals. Over the study period, the annual incidence of discharges after severe sepsis increased from 346/100 000 to 436/100 000 individuals (Table 1). Each year had a statistically significant increase (P < .05). Male predominance had a slight but significant increase (P < .05), going from 50.3% to 51.1%. There was no significant change in the median age at admission (

Discussion

Severe sepsis continues to be a significant burden on society due to its incidence, resource use, and significant mortality rate [1], [2], [3], [4]. We analyzed these and other epidemiologic factors related to severe sepsis using the most recent available HCUP NIS data in order to understand how these factors may be changing over time.

Before discussing our data, however, it is important to consider the method used when examining large databases, as this affects the results. Angus et al [14]

Conclusions

Severe sepsis continues to be a significant disease entity in all of its parameters. Although incidence continues to increase, it appears that the rate of increase may be reaching a plateau. Patients afflicted with this process most commonly are in their seventh decade of life. Individuals with multiple comorbidities continue to be afflicted. Overall mortality continues to decrease; however, those with multiple-organ failures still have an unacceptably high mortality rate. Indeed, those with 3

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