Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012

Kirsi Maija Kaukonen, Michael Bailey, Satoshi Suzuki, David Pilcher, Rinaldo Bellomo

Research output: Contribution to journalArticle

791 Citations (Scopus)

Abstract

IMPORTANCE: Severe sepsis and septic shock are major causes of mortality in intensive care unit (ICU) patients. It is unknown whether progress has been made in decreasing their mortality rate. OBJECTIVE: To describe changes in mortality for severe sepsis with and without shock in ICU patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, observational study from 2000 to 2012 including 101 064 patients with severe sepsis from 171 ICUs with various patient case mix in Australia and New Zealand. MAIN OUTCOMES AND MEASURES: Hospital outcome (mortality and discharge to home, to other hospital, or to rehabilitation). RESULTS: Absolute mortality in severe sepsis decreased from 35.0% (95% CI, 33.2%-36.8%; 949/2708) to 18.4% (95% CI, 17.8%-19.0%; 2300/12 512; P <.001), representing an overall decrease of 16.7% (95% CI, 14.8%-18.6%), an annual rate of absolute decrease of 1.3%, and a relative risk reduction of 47.5% (95% CI, 44.1%-50.8%). After adjusted analysis, mortality decreased throughout the study period with an odds ratio (OR) of 0.49 (95% CI, 0.46-0.52) in 2012, using the year 2000 as the reference (P <.001). The annual decline in mortality did not differ significantly between patients with severe sepsis and those with all other diagnoses (OR, 0.94 [95% CI, 0.94-0.95] vs 0.94 [95% CI, 0.94-0.94]; P = .37). The annual increase in rates of discharge to home was significantly greater in patients with severe sepsis compared with all other diagnoses (OR, 1.03 [95% CI, 1.02-1.03] vs 1.01 [95% CI, 1.01-1.01]; P <.001). Conversely, the annual increase in the rate of patients discharged to rehabilitation facilities was significantly less in severe sepsis compared with all other diagnoses (OR, 1.08 [95% CI, 1.07-1.09] vs 1.09 [95% CI, 1.09-1.10]; P <.001). In the absence of comorbidities and older age, mortality was less than 5%. CONCLUSIONS AND RELEVANCE: In critically ill patients in Australia and New Zealand with severe sepsis with and without shock, there was a decrease in mortality from 2000 to 2012. These findings were accompanied by changes in the patterns of discharge to home, rehabilitation, and other hospitals.

Original languageEnglish
Pages (from-to)1308-1316
Number of pages9
JournalJournal of the American Medical Association
Volume311
Issue number13
DOIs
Publication statusPublished - 2014
Externally publishedYes

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Septic Shock
New Zealand
Critical Illness
Sepsis
Mortality
Odds Ratio
Rehabilitation
Intensive Care Units
Shock
Diagnosis-Related Groups
Risk Reduction Behavior
Hospital Mortality
Observational Studies
Comorbidity
Retrospective Studies

ASJC Scopus subject areas

  • Medicine(all)

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Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. / Kaukonen, Kirsi Maija; Bailey, Michael; Suzuki, Satoshi; Pilcher, David; Bellomo, Rinaldo.

In: Journal of the American Medical Association, Vol. 311, No. 13, 2014, p. 1308-1316.

Research output: Contribution to journalArticle

Kaukonen, Kirsi Maija ; Bailey, Michael ; Suzuki, Satoshi ; Pilcher, David ; Bellomo, Rinaldo. / Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. In: Journal of the American Medical Association. 2014 ; Vol. 311, No. 13. pp. 1308-1316.
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N2 - IMPORTANCE: Severe sepsis and septic shock are major causes of mortality in intensive care unit (ICU) patients. It is unknown whether progress has been made in decreasing their mortality rate. OBJECTIVE: To describe changes in mortality for severe sepsis with and without shock in ICU patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, observational study from 2000 to 2012 including 101 064 patients with severe sepsis from 171 ICUs with various patient case mix in Australia and New Zealand. MAIN OUTCOMES AND MEASURES: Hospital outcome (mortality and discharge to home, to other hospital, or to rehabilitation). RESULTS: Absolute mortality in severe sepsis decreased from 35.0% (95% CI, 33.2%-36.8%; 949/2708) to 18.4% (95% CI, 17.8%-19.0%; 2300/12 512; P <.001), representing an overall decrease of 16.7% (95% CI, 14.8%-18.6%), an annual rate of absolute decrease of 1.3%, and a relative risk reduction of 47.5% (95% CI, 44.1%-50.8%). After adjusted analysis, mortality decreased throughout the study period with an odds ratio (OR) of 0.49 (95% CI, 0.46-0.52) in 2012, using the year 2000 as the reference (P <.001). The annual decline in mortality did not differ significantly between patients with severe sepsis and those with all other diagnoses (OR, 0.94 [95% CI, 0.94-0.95] vs 0.94 [95% CI, 0.94-0.94]; P = .37). The annual increase in rates of discharge to home was significantly greater in patients with severe sepsis compared with all other diagnoses (OR, 1.03 [95% CI, 1.02-1.03] vs 1.01 [95% CI, 1.01-1.01]; P <.001). Conversely, the annual increase in the rate of patients discharged to rehabilitation facilities was significantly less in severe sepsis compared with all other diagnoses (OR, 1.08 [95% CI, 1.07-1.09] vs 1.09 [95% CI, 1.09-1.10]; P <.001). In the absence of comorbidities and older age, mortality was less than 5%. CONCLUSIONS AND RELEVANCE: In critically ill patients in Australia and New Zealand with severe sepsis with and without shock, there was a decrease in mortality from 2000 to 2012. These findings were accompanied by changes in the patterns of discharge to home, rehabilitation, and other hospitals.

AB - IMPORTANCE: Severe sepsis and septic shock are major causes of mortality in intensive care unit (ICU) patients. It is unknown whether progress has been made in decreasing their mortality rate. OBJECTIVE: To describe changes in mortality for severe sepsis with and without shock in ICU patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, observational study from 2000 to 2012 including 101 064 patients with severe sepsis from 171 ICUs with various patient case mix in Australia and New Zealand. MAIN OUTCOMES AND MEASURES: Hospital outcome (mortality and discharge to home, to other hospital, or to rehabilitation). RESULTS: Absolute mortality in severe sepsis decreased from 35.0% (95% CI, 33.2%-36.8%; 949/2708) to 18.4% (95% CI, 17.8%-19.0%; 2300/12 512; P <.001), representing an overall decrease of 16.7% (95% CI, 14.8%-18.6%), an annual rate of absolute decrease of 1.3%, and a relative risk reduction of 47.5% (95% CI, 44.1%-50.8%). After adjusted analysis, mortality decreased throughout the study period with an odds ratio (OR) of 0.49 (95% CI, 0.46-0.52) in 2012, using the year 2000 as the reference (P <.001). The annual decline in mortality did not differ significantly between patients with severe sepsis and those with all other diagnoses (OR, 0.94 [95% CI, 0.94-0.95] vs 0.94 [95% CI, 0.94-0.94]; P = .37). The annual increase in rates of discharge to home was significantly greater in patients with severe sepsis compared with all other diagnoses (OR, 1.03 [95% CI, 1.02-1.03] vs 1.01 [95% CI, 1.01-1.01]; P <.001). Conversely, the annual increase in the rate of patients discharged to rehabilitation facilities was significantly less in severe sepsis compared with all other diagnoses (OR, 1.08 [95% CI, 1.07-1.09] vs 1.09 [95% CI, 1.09-1.10]; P <.001). In the absence of comorbidities and older age, mortality was less than 5%. CONCLUSIONS AND RELEVANCE: In critically ill patients in Australia and New Zealand with severe sepsis with and without shock, there was a decrease in mortality from 2000 to 2012. These findings were accompanied by changes in the patterns of discharge to home, rehabilitation, and other hospitals.

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