To the editor:
Increasing the resources available in healthcare settings to improve the detection of sepsis can significantly reduce mortality rates. These resources could include advanced diagnostic tools, sepsis screening protocols and ongoing medical education for healthcare providers, ensuring they are equipped to identify sepsis in its early stages [1]. Policies should advocate integrating sepsis detection systems into existing healthcare frameworks. The regional government of Catalonia has promoted such an action plan since its establishment in 2015. This action plan includes a programme called Sepsis Code, which was developed by seven scientific societies and the prehospital emergency department, and has been approved by healthcare policy stakeholders and implemented since 2017 [2]. Similar programmes have been implemented for other time-dependent diseases. The programme includes an organisational model according to hospital levels of care and locations, suggested training programmes (including an app), screening tools, and an automated registry.
This study aims to compare the quality of healthcare in Catalonia, a Spanish region with a programme for the rapid diagnosis and treatment of sepsis, with data from centres in the rest of the European Union.
Data from the European Sepsis Care Survey (ESCS) was used to analyse sepsis care in Catalan hospitals and compare it with data from 25 other countries of the European Union [3].
The survey was conducted online using the survey software LamaPoll, platin version (Lamano GmbH & Co. KG, Berlin, Germany). Data analysis was done by SPSS-IBM statistics version 26.0 and Excel. The study complies with the EQUATOR network reporting guidelines CHERRIES [4] and CROSS [5] and was registered at ClinicalTrials.gov (Identifier: NCT05059808).
Fifty-five percent (21/38) of hospitals in Catalonia with intensive care units (ICUs) were included, representing 100% (17/17) of public tertiary hospitals. These Catalonian hospitals were then compared with 691 centres from the European Union (including hospitals from other Spanish regions). Compared with the EU, hospitals in Catalonia had a higher rate of screening programmes implemented in the emergency department (95% [19/20] vs 53% [293/550] p < 0.001), and general wards (80% [16/20] vs 45% [255/568] p = 0.002). The rate of sepsis screening programmes was not different in Catalonian ICUs (79% [15/19] vs 61% [354/585], p = 0.10) (Fig. 1). Standardised sepsis management protocols in the emergency department were more prevalent in comparison with the EU (100% [20/20] vs 57% [309/544] p < 0.001), as well as in general wards (85% [17/20] vs 42% [234/554] p < 0.001) (Fig. 1), but not in the ICUs where standardised management was high in both settings (90% [17/19] vs 72% [412/575], p=0.088). Similar comparisons were performed, including only university hospitals, and in comparisons with other hospitals from Spain and are included in the Supplementary (Table S1 and Figs. S1 and S2).
Fig. 1.
Screening, standardised sepsis management and quality programs in hospitals from the European Union, and Catalonia. Data is presented as percentage with 95% confidence intervals (CIs)
Hospitals in Catalonia had more quality improvement programmes of any kind than hospitals in the EU (63% [12/19] vs 27% [159/598], p<0.001) (Fig. 1). The number of staff involved in sepsis training (as teacher or student) from the EDs and ICUs was similar in Catalonia and the EU, but lower in Catalan wards. Meetings scheduled for case discussion and training were more common in Catalonia than in the EU but this did not achieve statistical significance (83% [10/12] vs 66% [105/159], p= 0.218). In Catalonia, more quality indicators are recorded, especially time-to-antibiotics (50% [10/20] vs 16% [99/633], p < 0.001) and bundle compliance (55% [11/20] vs 12% [72/633], p < 0.001).
This retrospective post-hoc analysis revealed that, hospitals in Catalonia had better sepsis management and screening indicators than similar hospitals in the EU. At the same time, there were more sepsis programs implemented in Catalonia. This analysis was prompted by the high participation rate of tertiary hospitals from Catalonia in the survey, and the need to draw local conclusions for improvement in a region where a programme had been in place for five years prior to the survey. Since its implementation, the Sepsis Code has significantly impacted the management of sepsis in Catalonia. Hospitals and healthcare centres that have adopted the Sepsis Code have reported improvements in the early recognition and treatment of sepsis. One of the most significant impacts of the Sepsis Code has been a reduction in sepsis related mortality rates [6, 7]. Also, improvements in managing this condition has been reported in emergency department [7].
The main limitation of this study is that the results are based on a survey. While the information provided by department heads and consultants is considered reliable, it has not been audited or verified. Another important limitation is that a higher proportion of tertiary and university hospitals in Catalonia were included. Although we conducted sensitivity analyses showing similar results when comparing only university hospitals, we were unable to compare smaller hospitals. Additionally, we lack complete data on the number of hospitals in each included country and their complexity. A strength of this study is the high participation rate of hospitals in Catalonia, which represents all public tertiary hospitals with intensive care units.
In conclusion, hospitals in Catalonia, a region with a sepsis management programme (Codigo Sepsis) promoted by healthcare policy, have higher rates of sepsis screening and standardised sepsis management.
Supplementary Information
Acknowledgements
ESCS Steering Committee: Adam Linder (Lund, Sweden), Christian S. Scheer (Greifswald, Germany), Daniela Filipescu (Bucharest, Romania), Evangelos J. Giamarellos-Bourboulis (Athens, Greece), Evgeny A. Idelevich (Greifswald, Germany), Gabriella Bottari (Rome, Italy), Konrad Reinhart (Berlin, Germany), Manu LNG Malbrain (Antwerpen, Belgium), Marlies Ostermann (London, United Kingdom), Matthias Gründling (Greifswald, Germany), Ricard Ferrer (Barcelona, Spain), Said Laribi (Tours, France).
European Sepsis Care Study Group Collaborators:
A. Scharf, Adam Leoniuk, Adam Linder, Adrià Albis Guimet, Adriana América Da Silva, Adriana Cataldo, Agata Dąbkowska, Agneverszka Głusek, Aikaterini Ioakeimidou, Alberto del Castillo Blanco, Albertus Beishuizen, Aldona Szczepańska, Alejandro Martin-Quiros, Alejandro Rodriguez, Alessandra Oliva, Alessandro Manfredi, Alessia Franceschi, Alessio Bertini, Alessio Maroccia, Alexander Koch, Alexander Nicko, Alexandre Bleibtreu, Alfonso Arizmendi Demay, Ali Rezaei, Aliaksei Kazachonak, Alicja Bartkowska-Śniatkowska, Almudena Alonso Ojembarrena, Alvise Tosoni, Marco Daverio, Ana Margarida Correia, Ana Maria Munteanu, Anabela Bártolo, Anamaria Harabor, Anani Akpabie, Andrea Carsetti, Andrea Magaard, Andreas Ekman, Andreas Hecker, Andreas Nowak, Andreas Ostermeier, Andreas Prengel, Andreas Sielenkämper, Andreas Thierbach, Andriy Krystopchuk, Andrzej Pihowicz, ANeverk Crombach, Angela Liebke, Anita Lukic, Anja Heymann, Sebastian Baßeler, Anja-Tamara Lange, Anna Antes-żupa, Anna Efthymiou, Anna Eklund, Anna Lukaszewska, Anna Meuronen, Anna Patrizia Poli, Anna Radlińska, Anna Rekas-Dudziak, Anne Floor Heitz, Annelies Tacx, Anni Pulkkinen, Annmarie Lassen, Antonella Frattari, Antonella Viola, Antonija Vrbanić Šutalo, Antonio Carneiro, António Manuel Pereira De Figueiredo, Antti Mäkelä, Arion-Björn Paulus, Armin Sablotzki, Armin Seibel, Arne Röhrs, Athanasios Chalkias, Axel Neverrhaus, B. Anuszkiewicz, Balazs Kadar, Bartolo Michelangelo, Bea Van den Poel, Belinda De Simone, Benjamin Sasko, Bernd Müllejans, Bernhard Birmes, Bernuy Galvez Cesar, Berta Cisteró, Birgit Gottschlich, Biserka Mustac-Hlebec, Björn Jäschke, Boris E. Sakakushev, Bozidar Duplancic, Bruno Van Herendael, Bushra Ibrahim, Anna Mansson, Caitriona Rayner, Calancia Cosmin, Carla Hopper, Carles Triginer, Carlo Pallotto, Carmen Lauterbach, Carmen Rosa Fraga Quintana, Carolina S Romero, Caroline Riske, Caterina Gentili, Christian Byhahn, Christian Keuneke, Christian Prause, Christian Schlottke, Christina Lydon, Christine Weis, Christoph Büttner, Christoph Dodt, Christoph Peter, Christoph Plank, Christophe Aveline, Cinzia Barletta, Claudia Gutsche, Claudia Holzbauer, Constantin Bodolea, Cordula Thörmer, Johan Courjon, Cristian Cobilinschi, Cristina Honorato, Cristina López Viloria, Csaba Kopitkó, Dagmar Engemann, Dan Corneci, DaNeverl Bender, DaNeverla Ionescu, DaNeverle Orso, Daphne Annika van Rijssel, David Andaluz Ojeda, David Honan, David Míra, Dietmar Dörschner, Dietrich Keller, Dimitrios Schizas, Dimitris Bliamplias, Dirk Hinz, Dirk Meininger, Ditte Gry Strange, Djillali Annane, Astrid Schwurack, Dokoula Carine, Dominik Einwag, Dorel Sandesc, Ilse Van Cotthem, Eefje Verwulgen, Elena Chircov, Eleni Karlafti, Elina Riihioja, Elisabeth Montel, Elora Pavla Matanović, Els-Marie Rolén, Else van den Berg, Erica Sermijn, Ester Rovira Lázaro, Etienne Javouhey, Eva Schaden, Evangelia Michail Michailidou, Eveny Winklaar, Evgeni Dimitrov, Evgeni Nikolaev, Evy Voets, Ewa Zabul, F. Xavier López Altimiras, Fabio Caramelli, Fabrizio DAcapito, Fausto Catena, Ferran Llopis, Filip Abedinov, Filip Triest, Filippia Nikolaou, FIlippo Luciani, Fiona Moore, Florescu Simin Aysel, Florian Berteau, Florian Prätsch, Florian Schache, Florian Seidlitz, Florin Teodor Bobirca, Francesca Greco, Francesca Lelli, Francesco Fleres, Francisco Jose Ezponda, Franco Apra, Frank Fröhlich, Frank Hendrich, Frank Schleibach, Frank Wolffgramm, Frank Zoerner, Frank-Günter Mewes, Frank-R. Klefisch, Fredrik Schiöler, Friedrich Afflerbach, Fritz-Ulrich Hahne, Gabor Nardai, Gabriel Chiriac, Gabriel Petre Gorexki, Gabriele Racanelli, Gabriele Wolz, Gabriella Bottari, Gabriella Parisi, Garri Slobodianiuk, Genoveva Cadar, Georg Fritz, Georg Kreuzer, George Notas, George Sakka, Georgi Popivanov, Gerd Klinkmann, Giacinto Ida, Giannini Michele, Gideon Latten, Giovanna Maddalena, Gisa Andresen, Giuseppe Brisinda, Giuseppe Lauria, Goffredo Angioni, Göran Stenlund, Grzegorz Płoński, Günther Oprea, H.A.H. Kaasjager, H.R. Bouma, Haitham Mutlak, Hakan Ekvall, Hana Chmelíčková, Hannes Gabriel, Hassold Nolan, Hauke Rensing, Heike Schlegel-Höfner, Heiko Groth, Heiner Ruschulte, Heinrich V. Groesdonk, Hendrik Rüddel, Henning Jansen, Henrik Rueffert, Herbert Glenny Baquerizo Vargas, Iacopo Cappellini, Ibolya Toth, Ilka Schanz, Illes Hajnal-Gabriela, Ioana Grigoras, Ioannis Orfanos, Irena Osojnik, Ireneusz RzepNeverwski, Iris Klaus, Iris Koper, Iulia Bagiu, Iulia-Roxana Morlova, Ivan Herold, Ivana Pavlić, Ivo Schindler, Izzaddin Mohd, J. Kraßler, J. Miquel Morales, Jacek Prokopowicz, Jacob Packmohr, Jacobien Hoogerwerf, Jadranka Pavicic Saric, Jakub Bilski, Jan Beneš, Jan Breuls, Jan Castan, Jan Frič, Jan Mersmann, Jan P. Roesner, Jan Seemann, Jan Zatloukal, Jan-Hinrich Baumert, Jan-Jakob Meyer, Jana Fastnacht-Böttcher, Jana Protzel, Janos Szederjesi, Janusz Gruszczyk, Janusz Michalak, Jaroslav Houser, Jarosław Janc, Jarosław Luboński, Javier Hermida Yañez, Javier Pilar, Jean-Louis Vincent, Jean-Philippe Lanoix, Jelmer Alsma, Jens Christian Kubitz, Jens Döffert, Jens Eriksson, Jens Heidrich, Jens Soukup, Jeppe SA Neverlsen, Jeremie Pasquier, Jesper Svefors, Jesús Emilio Barrueco Francioni, Jiří Dvorský, Jiří Klimeš, Jiří Pařízek, Jiri Zurek, MD, Joanna Bartczak, Joanna Zorska, João Gamito Lopes, Joao Miguel Ribeiro, Johan Berkius, Johan Lindström, Johann Knotzer, Johanna Hästbacka, Johannes Rhein, Jolanta Wierzchowska, Jona Weißkirchen, Jonas Sunden-Cullberg, Jonas Tverring, Jörg Engel, Jörg Kappert, Jörg Rehlinghaus, José Artur Paiva, José Pedro Cidade, Josep Trenado, Juan Carlos Yebenes, Juan Fernando Gerber, Juan Jose Diaz, Juan Pablo Horcajada, Judit Kovacs, Julika Schön, Karel Maelegheer, Karina Stefańska-Wronka, Karl Reiter, Katarzyna Baścik, Katarzyna Skawińska, Katia Donadello, Katja Masjosthusmann, Kay-Lars Müller-Forte, Kelly Straka, Ken Dewitte, Kerstin Achmus-Stenz, Kim Jie, Kitty Slieker, Klaus Kogelmann, Knut Mauermann, Knut Müller, Koronakis Nikolaos, Kresimir Oremus, Kuido Nõmm, Lars Ljungström, Lars Witt, Laura Popa, Laura Ryan, Lavinia Ionescu, Lenneke van Lelyveld-Haas, Leo Licari, Liana Valeanu, Libor Zahradníček, Line Samuelsson, Lisa Mellhammar, Liudmila Hasak, Livia Vladoiu, Lorena Forcelledo Espina, Ludger Kämmerling, Luigi Bonavina, Luis Ensenat, Lukas Barnas, Lukas Lörinc, Łukasz Olendrzyński, Łukasz Rak, Lupe Coronel, Lutz Pfeiffer, M. Gryskova, M. Schüler, Maarit Hult, Maciej Gawor, Magdalena Miulescu, Magdalena Wujtewicz, Magnus von Seth, Maja Karaman Ilic, Malgorzata Mikaszewska-Sokoleiwcz, Malte Morisse, Meyer-Barner, Manelli Filippo, Manfred Hoefler, Manfred Nuscheler, Manole-Palivan Corina-Cecilia, Lupu Mary Nicoleta, Marc Beckers, Marc Bota, Marco Barchetti, Marco Ingrosso, Marco Ripa, Maria Andersson, Maria De Marco, Maria Fortofoiu, Maria Galiana Ivars, María José Pérez Pedrero, María Juliana Hernández Benito, Maria Slocker Barrio, Maria Zach, Mariana Anghele, Mario Guarino, Mariola Maciaszek, Mariola Tałałaj, Marisa Ann Capaldi, Marius Papurica, Mark Neufang, Markus Bressler, Markus Eller, Markus Kestler, Markus Kredel, Markus Rudnick, Markus Teipel, Marta Valcarcel Rodriguez,
Martijn van Tellingen, Martin Beiderlinden, Martin Bier, Martin Cermak, Martin Ebert, Martin Helan, Martin Kahl, Martin Metelka, Martin Reichert, Martin Schütz, Martin Spångfors, Martin Wagner, Martina Čehulić, Martina Pavletić, Marton Gyenge, Mary Bedding, Marzouk Mehdi, Maša Biberič, Mateusz Miszczyszyn, Mathias Fischer, Mathias Sprenger, Matija Belavić, Matija Jurjević, Matjaž Groznik, Matthias Gründling, Matthias Huck, Matthias Lutze, Matthias Menzel, Matthias Schmauß, Matthias Weiß, Maurizio Mazzoni, Max Müller, Jochen Souquet, Maximilian Ragaller, Mercedes Ibarz Villamayor, Michael Booke, Michael Buerke, Michael Dalager-Pedersen, Michael Dolch, Michael Fries, Michael Habenicht, Michael Kremer, Michael Meisner, Michael Meyer, Michael Pogatschnigg, Michael Schütz, Michael Stofkoper, Michal Holub, Michal Pelíšek, Michal Sitina, Michał Śpiewak, Michał Ziółkowski, Michelle Behan, Miguel Castelo-Branco Sousa, Mihaela Blaj, Mihaela Conci, Mihaela Lupse, Mika Valtonen, Mikael Moriconi, Minaříková Dagmar, Miroslav Zajicek, Mirza Aun Muhammad Baig, Mitre Ioan Remus, Modesto Martinez Pillado, Mohamed Hasaballah, Monique van der Lugt, Moritz Unglaube, Mrozek, Nádia Guimarães, Nahema Issa, Nathalie Layios, Naya Bellaubí Pallarés, Nelson Barros, Neverves Carbonell Monleón, Nicolas Belaube, Nicolas Mongardon, Nicolas Serck, Nikolaas Verbeke, Nikolas Lambiris, Nikoletta Rovina, Nils Haake, Nina Polze, Nina Sulen, Noelia María Muñoz Guillen, Nora Bruns, Noud Buenen, Ojan Assadian, Ole Broch, Olena Oliwa, Olga Klementová, Oliver Beck, Oliver Habler, Oliver Hensel, Oliver Kunitz, Oliver Schmid, Olof Blivik, Ondrej Zika, Onnen Mörer, Orestis Ioannidis, Oskar Ljungquist, Pablo Vidal Cortés, Paola Rodari, Papa Raffaella, Pär Lindgren, Pascal Stammet, Pasquale Minchella, Patricia Patricio, Patrik Gille-Johnson, Patrizia Petricci, Paula Pestana, Paula Vera, Pavel Dostal, Pavel Malina, Pavel Sedlák, Pedro Castro Rebollo, Pedro Rascado Sedes, Peter Brand, Peter Neumann, Petr Hubacek, Petr Stepanek, Petr Uhlig, Petra Wegermann, Philipp Tsafoulis, Pierre Fillatre, Pierre Gregoire Guinot, Pierre Tattevin, Pio Faust, Piotr Czempik, Piotr Smuszkiewicz, Piotr StaNeverwski, Plinio Calligaro, Polychronis Tassioudis, Přemysl Dörr, Przemysław Michalski, R. Klimaschewski, R. Schnabel, Radek Cihlář, Rafael Leon Lopez, Rafał Gałuszka, Rafał Wójtowicz, Rainer Haas, Ralf Walper, Ralph Budnik, Ralph Sander, Raphael Gukasjan, Reiner Sitzler, Reinoud Cartuyvels, Renata Szmigielska, Renate Koch, René Verbeek, Ricard Ferrer, Ricardo Castelbón, Rob Wilting, Robert Bocek, Robert Janda, Roberta Moretti, Roelie Wösten-van Asperen, Romain Jouffroy, Romaric Larcher, Ronald Seidel, Rosario Cristoforo Puleo, Rouven-Alexander von Holten, Roxana Ungurean, Rüdiger Albrecht, Rüdiger Lott, Rui Terras, Rute Fernandes Alves, Ruth Müller, Ryszard Tokarczuk, Salla Kumpulainen, Sami Mäenpää, Sandra Müller, Sandra O Donovan, Sanna Pohjanpaju, Sara Cajander, Sascha Ussat, Saviano Angela, Sebastian Brandt, Sebastian Casu, Sebastian Hafner, Sebastian Hammerich, Sebastian Rehberg, Sebastian Tranca, Selena Knoth, Shahram Mashayekhi, Shona Fitzgerald, Silvana Pilia, Silvia Carbajo Azabal, Silvia De Rosa, Simo-Pekka Koivisto, Simon Oelsner, Simon Schäfer, Simona Barnini, Simona Viola, Simu Tudor, Sinead ONeill, Siwanczak, Söhnke Boye, Sonja Krofak, Spadaro Savino, Staffan Tevell, Stefan Angermair, Stefan Bergt, Stefan Markoff, Stefan Ostmeier,Stefan Otto, Stefan P. Wirtz, Stefan Rußwurm, Stefan Schroeder, Stefan Staar, StefaNever Vandervelden, Stefano Trapassi, Steffen Volkert, Stepani Bendel, Stephan Baumann, Stephan Blache, StephaNever Koster, StephaNever Mifsud, Sulamita Carvalho Brugger, Sunil Jagoda, Sven Ackermann, Sybille Glöckl, T. Dormans, Tajana Milanovic Robina, Talvikki Koskue, Tatiana Ciomartan, Teresa Tomasa, Theodoros Aslanidis, Thessa VerNeverst, Thomas Eckermann, Thomas Grau, Thomas Hahn, Thomas Kiss, Thomas Libuda, Thomas Melzer, Thomas Rösel, Thomas Uhlig, Thomas Volk, Thomas Weidermann, Thorsten Keil, Tim Bruckmoser, Tim Piepho, Timmermans Mark, Tina Frolo, Tina Tomić Mahečić, Toamas Gabrhelik, Tobias Gropp, Tobias Klöpper, Tobias Lahmer, Tobias Leipold, Tomáš Málek, Tomáš Tajč, Tomas Urbina, Tomas Vymazal, Tomasz Musiuk, Tomasz Siegel, Tomasz Skalec, Torsten Fricke, Udo Gottschaldt, Ulf Linstedt, Ulrich Blumenthal, Ulrich Katt, Ulrich Plog, Ulrich Ronellenfitsch, Ursula George, Ute Brüggemann, Uwe Treue, Václava Adámková, Valeria Caramello, Vasileios Kaldis, Vasileios Nolas, Vasilios Papaioannou, Verena Plötz, Vesna Degoricija, Viktor Švigelj, Ville Jalkanen, Vincenzo Francesco Tripodi, Vladimír Zemánek, Volker Ostermoor, W. Alexander Osthaus, W. Joost Wiersinga, W.B. Huiszoon, Wahid Altaf, Waldemar Sobolewski, Walravens Stig, Walter Stadlmeyer, Wiktoria Mizak, Witold Wasiak, Wojciech Dabrowski, Wolfgang Heinke, Wolfgang Zink, Xavier Muschart, Yuriy Bunin, Yvo Boué, Yvonne Young, Zdenek Kos, Zdenko Povšić-Čevra, Zrinka Safaric Oremus, Zuzanna Górska.
We acknowledge the endorsing scientific societies ESAIC, ESGBIES (from ESCMID), EUSEM, ESICM, ESPNIC, ESS, ICS UK and IFA, which supported the dissemination of the survey. We would also like to thank all participants, also the participants who did not consent to being named in the collaborators list. We thank Simone Mancini from GlobalSepsis Alliance for organizing and coordinating the steering committee meetings.
Author contributions
CS, RF, AL, DF, EI, EGB, and AA participated in protocol development, study design, and study management; AC, CS, EGB, and AA interpreted the data. CS participated in the statistical analysis. AC, wrote the draft. RF, JT, CL, JY, and AA performed centre recruitment and data collection. European Sepsis Care Study Group collaborators participated in data collection. All authors read and approved the final version of the manuscript.
Funding
TheEuropean Sepsis Care Survey was funded by the European Sepsis Alliance and an educational grant by Becton Dickinson S.A. (BD). BD was neither involved in the study design and recruitment nor in writing or reviewing or submission of the manuscript. This article represents the views of the named authors only.
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The study received ethical approval (BB 124/21) from the ethics committee of the University Medicine Greifswald, Germany, where data have been collected and processed. All participants gave their consent to participate electronically. Participation was not possible without this consent.
The study was registered at https://clinicaltrials.gov/ (Identifier: NCT05059808), registration date 2021-08-31.
Consent for publication
The manuscript contains not individual person’s data in any form. Availability of data and materials. The data used for this analysis can be made available upon reasonable request for up to five years. For further information, please contact the corresponding author.
Competing interests
Christian S. Scheerhas received funding from the European Sepsis Alliance for the conduction the European Sepsis Care Survey and funding from Becton and Dickinson for the technical realization of the project. Consulting fees from Becton and Dickinson. The other authors declare have no conflict of interest.
Footnotes
Publisher's Note
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Adrian Ceccato and Christian S. Scheer contributed equally.
Contributor Information
Adrian Ceccato, Email: aartigas@tauli.cat.
the European Sepsis Care Study Group:
A. Scharf, Adam Leoniuk, Adam Linder, Adriana Cataldo, Agata Dąbkowska, Agneverszka Głusek, Aikaterini Ioakeimidou, Albertus Beishuizen, Aldona Szczepańska, Alejandro Martin-Quiros, Alejandro Rodriguez, Alessandra Oliva, Alessandro Manfredi, Alessia Franceschi, Alessio Bertini, Alessio Maroccia, Alexander Koch, Alexander Nicko, Alexandre Bleibtreu, Ali Rezaei, Aliaksei Kazachonak, Alicja Bartkowska-Śniatkowska, Alvise Tosoni, Marco Daverio, Anabela Bártolo, Anamaria Harabor, Anani Akpabie, Andrea Carsetti, Andrea Magaard, Andreas Ekman, Andreas Hecker, Andreas Nowak, Andreas Ostermeier, Andreas Prengel, Andreas Sielenkämper, Andreas Thierbach, Andriy Krystopchuk, Andrzej Pihowicz, A. Neverk Crombach,, Angela Liebke, Anita Lukic, Anja Heymann, Sebastian Baßeler, Anja-Tamara Lange, Anna Antes-żupa, Anna Efthymiou, Anna Eklund, Anna Lukaszewska, Anna Meuronen, Anna Radlińska, Anna Rekas-Dudziak, Annelies Tacx, Anni Pulkkinen, Annmarie Lassen, Antonella Frattari, Antonella Viola, Antonio Carneiro, Antti Mäkelä, Arion-Björn Paulus, Armin Sablotzki, Armin Seibel, Arne Röhrs, Athanasios Chalkias, Axel Neverrhaus, B. Anuszkiewicz, Balazs Kadar, Bartolo Michelangelo, Benjamin Sasko, Bernd Müllejans, Bernhard Birmes, Berta Cisteró, Birgit Gottschlich, Biserka Mustac-Hlebec, Björn Jäschke, Boris E. Sakakushev, Bozidar Duplancic, Bruno Van Herendael, Bushra Ibrahim, Anna Mansson, Caitriona Rayner, Calancia Cosmin, Carla Hopper, Carles Triginer, Carlo Pallotto, Carmen Lauterbach, Carolina S Romero, Caroline Riske, Caterina Gentili, Christian Byhahn, Christian Keuneke, Christian Prause, Christian Schlottke, Christina Lydon, Christine Weis, Christoph Büttner, Christoph Dodt, Christoph Peter, Christoph Plank, Christophe Aveline, Cinzia Barletta, Claudia Gutsche, Claudia Holzbauer, Constantin Bodolea, Cordula Thörmer, Johan Courjon, Cristian Cobilinschi, Cristina Honorato, Csaba Kopitkó, Dagmar Engemann, Dan Corneci, DaNeverl Bender, DaNeverla Ionescu, DaNeverle Orso, David Honan, David Míra, Dietmar Dörschner, Dietrich Keller, Dimitrios Schizas, Dimitris Bliamplias, Dirk Hinz, Dirk Meininger, Djillali Annane, Astrid Schwurack, Dokoula Carine, Dominik Einwag, Dorel Sandesc, Ilse Van Cotthem, Eefje Verwulgen, Elena Chircov, Eleni Karlafti, Elina Riihioja, Elisabeth Montel, Els-Marie Rolén, Erica Sermijn, Etienne Javouhey, Eva Schaden, Eveny Winklaar, Evgeni Dimitrov, Evgeni Nikolaev, Evy Voets, Ewa Zabul, F. Xavier López Altimiras, Fabio Caramelli, Fabrizio DAcapito,, Fausto Catena, Ferran Llopis, Filip Abedinov, Filip Triest, Filippia Nikolaou, FIlippo Luciani, Fiona Moore, Florian Berteau, Florian Prätsch, Florian Schache, Florian Seidlitz, Francesca Greco, Francesca Lelli, Francesco Fleres, Franco Apra, Frank Fröhlich, Frank Hendrich, Frank Schleibach, Frank Wolffgramm, Frank Zoerner, Frank-Günter Mewes, Frank-R. Klefisch, Fredrik Schiöler, Friedrich Afflerbach, Fritz-Ulrich Hahne, Gabor Nardai, Gabriel Chiriac, Gabriele Racanelli, Gabriele Wolz, Gabriella Bottari, Gabriella Parisi, Garri Slobodianiuk, Genoveva Cadar, Georg Fritz, Georg Kreuzer, George Notas, George Sakka, Georgi Popivanov, Gerd Klinkmann, Giacinto Ida, Giannini Michele, Gideon Latten, Giovanna Maddalena, Gisa Andresen, Giuseppe Brisinda, Giuseppe Lauria, Goffredo Angioni, Göran Stenlund, Grzegorz Płoński, Günther Oprea, H.A.H. Kaasjager, H.R. Bouma, Haitham Mutlak, Hakan Ekvall, Hana Chmelíčková, Hannes Gabriel, Hassold Nolan, Hauke Rensing, Heike Schlegel-Höfner, Heiko Groth, Heiner Ruschulte, Heinrich V. Groesdonk, Hendrik Rüddel, Henning Jansen, Henrik Rueffert, Iacopo Cappellini, Ibolya Toth, Ilka Schanz, Illes Hajnal-Gabriela, Ioana Grigoras, Ioannis Orfanos, Irena Osojnik, Ireneusz RzepNeverwski, Iris Klaus, Iris Koper, Iulia Bagiu, Iulia-Roxana Morlova, Ivan Herold, Ivana Pavlić, Ivo Schindler, Izzaddin Mohd, J. Kraßler, J. Miquel Morales, Jacek Prokopowicz, Jacob Packmohr, Jacobien Hoogerwerf, Jakub Bilski, Jan Beneš, Jan Breuls, Jan Castan, Jan Frič, Jan Mersmann, Jan P. Roesner, Jan Seemann, Jan Zatloukal, Jan-Hinrich Baumert, Jan-Jakob Meyer, Jana Fastnacht-Böttcher, Jana Protzel, Janos Szederjesi, Janusz Gruszczyk, Janusz Michalak, Jaroslav Houser, Jarosław Janc, Jarosław Luboński, Javier Hermid, Javier Pilar, Jean-Louis Vincent, Jean-Philippe Lanoix, Jelmer Alsma, Jens Döffert, Jens Eriksson, Jens Heidrich, Jens Soukup, Jeppe SA Neverlsen, Jeremie Pasquier, Jesper Svefors, Jiří Dvorský, Jiří Klimeš, Jiří Pařízek, Jiri Zurek, Joanna Bartczak, Joanna Zorska, Johan Berkius, Johan Lindström, Johann Knotzer, Johanna Hästbacka, Johannes Rhein, Jolanta Wierzchowska, Jona Weißkirchen, Jonas Sunden-Cullberg, Jonas Tverring, Jörg Engel, Jörg Kappert, Jörg Rehlinghaus, Josep Trenado, Judit Kovacs, Julika Schön, Karel Maelegheer, Karina Stefańska-Wronka, Karl Reiter, Katarzyna Baścik, Katarzyna Skawińska, Katia Donadello, Katja Masjosthusmann, Kay-Lars Müller-Forte, Kelly Straka, Ken Dewitte, Kerstin Achmus-Stenz, Kim Jie, Kitty Slieker, Klaus Kogelmann, Knut Mauermann, Knut Müller, Koronakis Nikolaos, Kresimir Oremus, Kuido Nõmm, Lars Ljungström, Lars Witt, Laura Popa, Laura Ryan, Lavinia Ionescu, Lenneke van Lelyveld-Haas, Leo Licari, Liana Valeanu, Libor Zahradníček, Line Samuelsson, Lisa Mellhammar, Liudmila Hasak, Livia Vladoiu, Ludger Kämmerling, Luigi Bonavina, Luis Ensenat, Lukas Barnas, Lukas Lörinc, Łukasz Olendrzyński, Łukasz Rak, Lupe Coronel, Lutz Pfeiffer, M. Gryskova, M. Schüler, Maarit Hult, Maciej Gawor, Magdalena Miulescu, Magdalena Wujtewicz, Malgorzata Mikaszewska-Sokoleiwcz, Malte Morisse, Meyer-Barner, Filippo, Manfred Hoefler, Manfred Nuscheler, Manole-Palivan Corina-Cecilia, Marc Beckers, Marc Bota, Marco Barchetti, Marco Ingrosso, Marco Ripa, Maria Andersson, Maria Fortofoiu, Maria Zach, Mariana Anghele, Mario Guarino, Mariola Maciaszek, Mariola Tałałaj, Marius Papurica, Mark Neufang, Markus Bressler, Markus Eller, Markus Kestler, Markus Kredel, Markus Rudnick, Markus Teipel, Martijn van Tellingen, Martin Beiderlinden, Martin Bier, Martin Cermak, Martin Ebert, Martin Helan, Martin Kahl, Martin Metelka, Martin Reichert, Martin Schütz, Martin Spångfors, Martin Wagner, Martina Čehulić, Martina Pavletić, Marton Gyenge, Mary Bedding, Marzouk Mehdi, Maša Biberič, Mateusz Miszczyszyn, Mathias Fischer, Mathias Sprenger, Matija Belavić, Matija Jurjević, Matjaž Groznik, Matthias Gründling, Matthias Huck, Matthias Lutze, Matthias Menzel, Matthias Schmauß, Matthias Weiß, Maurizio Mazzoni, Max Müller, Jochen Souquet, Maximilian Ragaller, Michael Booke, Michael Buerke, Michael Dalager-Pedersen, Michael Dolch, Michael Fries, Michael Habenicht, Michael Kremer, Michael Meisner, Michael Meyer, Michael Pogatschnigg, Michael Schütz, Michael Stofkoper, Michal Holub, Michal Pelíšek, Michal Sitina, Michał Śpiewak, Michał Ziółkowski, Michelle Behan, Mihaela Blaj, Mihaela Conci, Mihaela Lupse, Mika Valtonen, Mikael Moriconi, Minaříková Dagmar, Miroslav Zajicek, Mohamed Hasaballah, Moritz Unglaube, Mrozek, Nádia Guimarães, Nahema Issa, Nathalie Layios, Nelson Barros, Nicolas Belaube, Nicolas Mongardon, Nicolas Serck, Nikolaas Verbeke, Nikolas Lambiris, Nikoletta Rovina, Nils Haake, Nina Polze, Nina Sulen, Nora Bruns, Noud Buenen, Ojan Assadian, Ole Broch, Olena Oliwa, Olga Klementová, Oliver Beck, Oliver Habler, Oliver Hensel, Oliver Kunitz, Oliver Schmid, Olof Blivik, Ondrej Zika, Onnen Mörer, Orestis Ioannidis, Oskar Ljungquist, Paola Rodari, Papa Raffaella, Pär Lindgren, Pascal Stammet, Pasquale Minchella, Patricia Patricio, Patrik Gille-Johnson, Patrizia Petricci, Paula Pestana, Paula Vera, Pavel Dostal, Pavel Malina, Pavel Sedlák, Peter Brand, Peter Neumann, Petr Hubacek, Petr Stepanek, Petr Uhlig, Petra Wegermann, Philipp Tsafoulis, Pierre Fillatre, Pierre Tattevin, Pio Faust, Piotr Czempik, Piotr Smuszkiewicz, Piotr StaNeverwski, Plinio Calligaro, Polychronis Tassioudis, Přemysl Dörr, Przemysław Michalski, R. 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Dormans, Talvikki Koskue, Tatiana Ciomartan, Teresa Tomasa, Theodoros Aslanidis, Thessa VerNeverst, Thomas Eckermann, Thomas Grau, Thomas Hahn, Thomas Kiss, Thomas Libuda, Thomas Melzer, Thomas Rösel, Thomas Uhlig, Thomas Volk, Thomas Weidermann, Thorsten Keil, Tim Bruckmoser, Tim Piepho, Timmermans Mark, Tina Frolo, Toamas Gabrhelik, Tobias Gropp, Tobias Klöpper, Tobias Lahmer, Tobias Leipold, Tomáš Málek, Tomáš Tajč, Tomas Urbina, Tomas Vymazal, Tomasz Musiuk, Tomasz Siegel, Tomasz Skalec, Torsten Fricke, Udo Gottschaldt, Ulf Linstedt, Ulrich Blumenthal, Ulrich Katt, Ulrich Plog, Ulrich Ronellenfitsch, Ursula George, Ute Brüggemann, Uwe Treue, Václava Adámková, Valeria Caramello, Vasileios Kaldis, Vasileios Nolas, Vasilios Papaioannou, Verena Plötz, Vesna Degoricija, Viktor Švigelj, Ville Jalkanen, Vladimír Zemánek, Volker Ostermoor, W. Alexander Osthaus, W. Joost Wiersinga, W.B. 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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.