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      Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

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          Abstract

          Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis). There were 5317 in-patients in the 24-hour study period. Data were returned on 1198 digital data collection forms on patients with NEWS≥3 of which 87 were removed, leaving 1111 for analysis. 146 patients had sepsis and 144 patients had severe sepsis. Combined prevalence of sepsis and severe sepsis was 5.5% amongst all in-patients. Patients with sepsis had significantly higher NEWS scores (3 IQR 3–4 for non-sepsis and 4 IQR 3–6 for sepsis patients, respectively). Common organ dysfunctions in severe sepsis were hypoxia (47%), hypoperfusion (40%) and acute kidney injury (25%). Mortality at 90 days was 31% with a median (IQR) hospital free stay of 78 (36–85) days. Screening for sepsis, referral to Critical Care and completion of Sepsis 6 bundle was low: 26%, 16% and 12% in the sepsis group. Multivariable logistic regression analysis identified higher National Early Warning Score, diabetes, COPD, heart failure, malignancy and current or previous smoking habits as independent variables suggesting the diagnosis of sepsis. We observed that sepsis is more prevalent in the general ward and ED than previously suggested before and that screening and effective treatment for sepsis and severe sepsis is far from being operationalized in this environment, leading to high 90 days mortality.

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          Systemic inflammatory response syndrome criteria in defining severe sepsis.

          Kirsi-Maija Kaukonen, Michael Bailey, David Pilcher … (2015)
          The consensus definition of severe sepsis requires suspected or proven infection, organ failure, and signs that meet two or more criteria for the systemic inflammatory response syndrome (SIRS). We aimed to test the sensitivity, face validity, and construct validity of this approach.
          Article 0 comments Cited 334 times – based on 0 reviews     Review now
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            Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study.

            Andrew Rhodes, Richard Beale, John G. Phillips … (2012)
            Mortality from severe sepsis and septic shock differs across continents, countries, and regions. We aimed to use data from the Surviving Sepsis Campaign (SSC) to compare models of care and outcomes for patients with severe sepsis and septic shock in the USA and Europe. The SSC was introduced into more than 200 sites in Europe and the USA. All patients identified with severe sepsis and septic shock in emergency departments or hospital wards and admitted to intensive care units (ICUs), and those with sepsis in ICUs were entered into the SSC database. Patients entered into the database from its launch in January, 2005, through January, 2010, in units with at least 20 patients and 3 months of enrolment of patients were included in this analysis. Patients included in the cohort were limited to those entered in the first 4 years at every site. We used random-effects logistic regression to estimate the hospital mortality odds ratio (OR) for Europe relative to the USA. We used random-effects linear regression to find the relation between lengths of stay in hospital and ICU and geographic region. 25 375 patients were included in the cohort. The USA included 107 sites with 18 766 (74%) patients, and Europe included 79 hospital sites with 6609 (26%) patients. In the USA, 12 218 (65·1%) were admitted to the ICU from the emergency department whereas in Europe, 3405 (51·5%) were admitted from the wards. The median stay on the hospital wards before ICU admission was longer in Europe than in the USA (1·0 vs 0·1 days, difference 0·9, 95% CI 0·8-0·9). Raw hospital mortality was higher in Europe than in the USA (41·1%vs 28·3%, difference 12·8, 95% CI 11·5-14·7). The median length of stay in ICU (7·8 vs 4·2 days, 3·6, 3·3-3·7) and hospital (22·8 vs 10·5 days, 12·3, 11·9-12·8) was longer in Europe than in the USA. Adjusted mortality in Europe was not significantly higher than that in the USA (32·3%vs 31·3%, 1·0, -1·7 to 3·7, p=0·468). Complete compliance with all applicable elements of the sepsis resuscitation bundle was higher in the USA than in Europe (21·6%vs 18·4%, 3·2, 2·2-4·4). The significant difference in unadjusted mortality and the fact that this difference disappears with severity adjustment raise important questions about the effect of the approach to critical care in Europe compared with that in the USA. The effect of ICU bed availability on outcomes in patients with severe sepsis and septic shock requires further investigation. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward.

              R D Luna, Oscar Peñuelas, Federico Gordo … (2007)
              To describe the outcome of patients with sepsis according to location on a ward or in an intensive care unit. Prospective multicentered observational study. Three academic hospitals in Madrid, Spain. Consecutive patients with sepsis admitted to participating hospitals from March 1 to June 30, 2003. None. During the study period, 15,852 patients >18 yrs of age were admitted. Sepsis was identified in 702 patients, giving an estimated cumulative incidence rate of 367 cases per 100,000 adult area residents per year and a cumulative incidence rate among patients admitted to the hospital of 4.4%. Most septic patients had a community-acquired infection (71%). Severe sepsis developed in 199 patients (incidence rate, 104 cases per 100,000 adult area residents per year), and 59 patients developed septic shock (incidence rate, 31 cases per 100,000 adult area residents per year). Most of the patients met the criteria for severe sepsis or septic shock on the same day that they would have qualified for the septic status one step down the scale. In the other patients, the median time between sepsis and severe sepsis was 2 days (interquartile range, 2-5) and between severe sepsis and septic shock was 3 days (interquartile range, 1-4). Only 32% of severe sepsis patients received intensive care. The hospital mortality for all septic patients was 12.8%; for severe sepsis, 20.7%; and for septic shock, 45.7%. This study shows the high incidence of sepsis in a general population of patients admitted to hospital. A significant proportion of patients with severe sepsis are not transferred to the intensive care unit.
              Article 0 comments Cited 114 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Sanjay Haresh Chotirmall: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 1 December 2016
                Publication date Collection: 2016
                Volume: 11
                Issue: 12
                Electronic Location Identifier: e0167230
                Affiliations
                [1 ]Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
                [2 ]ACT Directorate, Cwm Taf University Health Board, Llantrisant, United Kingdom
                [3 ]Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom
                [4 ]Critical Care Directorate, Cardiff and Vale University Health Board, Cardiff, United Kingdom
                Lee Kong Chian School of Medicine, SINGAPORE
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: TS GE PM JEH.

                • Data curation: BS RL.

                • Formal analysis: TS.

                • Funding acquisition: TS.

                • Investigation: RL BS MK AD CM DD SR EB FH GC HT JH JL LD MA MJ NJ RM YI.

                • Methodology: TS RL BS GE PM JEH.

                • Project administration: TS RL BS MK AD CM DD SR EB FH GC HT JH JL LD MA MJ NJ RM YI.

                • Resources: TS BS RL.

                • Software: BS RL.

                • Supervision: TS JEH.

                • Validation: TS RL BS.

                • Visualization: TS.

                • Writing – original draft: TS GE PM JEH BS RL.

                • Writing – review & editing: RL BS MK AD CM DD SR EB FH GC HT JH JL LD MA MJ NJ RM YI.

                [¤]

                Current address: Department of Anaesthetics and Critical Care, Aneurin Bevan University Health Board, Newport, United Kingdom

                ¶ Membership of the Welsh Digital Data Collection Platform Collaborators is provided in the Acknowledgments.

                Author information
                http://orcid.org/0000-0003-3632-8844
                Article
                Publisher ID: PONE-D-16-21812
                DOI: 10.1371/journal.pone.0167230
                PMC ID: 5132245
                PubMed ID: 27907062
                SO-VID: 70cb9848-1cf9-47c8-b7d5-e95b23a5e1c4
                Copyright © © 2016 Szakmany et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 1 June 2016
                Date accepted : 10 November 2016
                Page count
                Figures: 1, Tables: 6, Pages: 12
                Funding
                Funded by: National Institute of Social and Health Care Research
                Award ID: NISCHR AHSC CRT Fellow 2012/13
                Award Recipient :
                Funded by: Welsh Intensive Care Society
                Award Recipient : Welsh Digital Data Collection Platform Collaborators
                Funded by: UK Sepsis Trust
                Award Recipient :
                ORCID: http://orcid.org/0000-0003-3632-8844
                Funded by: Cwm Taf University Health Board
                Award Recipient :
                ORCID: http://orcid.org/0000-0003-3632-8844
                This study was funded from grants from the Welsh Intensive Care Society, the UK Sepsis Trust, Cwm Taf University Health Board and Health and Care Research Wales. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Signs and Symptoms
                Subject: Sepsis
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Signs and Symptoms
                Subject: Sepsis
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Signs and Symptoms
                Subject: Sepsis
                Subject: Severe Sepsis
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Signs and Symptoms
                Subject: Sepsis
                Subject: Severe Sepsis
                Subject: Medicine and Health Sciences
                Subject: Critical Care and Emergency Medicine
                Subject: People and places
                Subject: Geographical locations
                Subject: Europe
                Subject: United Kingdom
                Subject: Wales
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Facilities
                Subject: Hospitals
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Observational Studies
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Signs and Symptoms
                Subject: Sepsis
                Subject: Systemic Inflammatory Response Syndrome
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Signs and Symptoms
                Subject: Sepsis
                Subject: Systemic Inflammatory Response Syndrome
                Subject: Medicine and Health Sciences
                Subject: Endocrinology
                Subject: Endocrine Disorders
                Subject: Diabetes Mellitus
                Subject: Medicine and Health Sciences
                Subject: Metabolic Disorders
                Subject: Diabetes Mellitus
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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