Table 2.
Comparison of major international studies on secular trends in sepsis incidence and mortality
| Kaukonen et al. [24] | Mellhammer et al. [13] | Shankar-Hari et al. [25] | Rhee et al. [12] | Fleischmann et al. [19] | |
|---|---|---|---|---|---|
| Country | Australia, New Zealand | Sweden, 2 regions | England | USA | Germany |
| Study period | 2000–2012 | 2015 | 2000–2012 | 2009–2014 | 2010–2015 |
| Study population | Adult patients from 171 ICUs | Adult patients from 11 hospitals who were started on an intravenous antibiotic therapy | Adult patients from 181 ICUs | Adults patients from 409 hospitals | All patients from nearly all acute-care hospitals in Germany |
| Data base | ICU patient database | Manual patient chart review and administrative hospital ICD discharge data | ICU patient database | Electronic health records (EHR) and administrative ICD hospital discharge diagnoses | Nation-wide database of administrative ICD hospital discharge diagnoses |
| Sepsis definition | Traditional severe sepsis: defined by the presence of 2 or more SIRS criteria within the first 24 h after ICU admission and infection accompanied by organ failure | Traditional severe sepsis: hypotension, hypoperfusion, or organ dysfunction induced by sepsisa | Traditional severe sepsis claims-based definition, explicit ICD-9-CM codes for severe sepsis (995.92) and septic shock (785.52) | Traditional severe sepsis: claims-based definition, identified by explicit ICD-10-GM codes for severe sepsis (R65.1) and septic shock (R57.2) | |
| Sepsis-3: organ dysfunction characterized by a rise in total SOFA ≥ 2 due to a dysregulated host response to infection | Sepsis-3: any admission clinically coded as infection and at least one organ dysfunction | Sepsis-3: clinical indicators of presumed infection and concurrent acute organ dysfunction in EHR | |||
| Age | Mean (95% CI) in 2000–2012: 63.5 (63.3–63.6) | Median in 2015: 78 (trad.) and 80 (sepsis-3) | Mean (SD) in 2012: 64.2 (16.4) | Mean (SD) in 2014: 66.5 (15.5) (sepsis-3) | Mean (SD) in 2014: 70.0 (15.8) |
| Hospital admission rate | Traditional severe sepsis: 9.7/100 ICU admissions over entire study period | Traditional severe sepsis: 2.7/100 hospital admissions in 2014 | Traditional severe sepsis: 0.73/100 hospital admissions in 2015 | ||
| Sepsis-3: 25.2/100 ICU admissions in 2012 | Sepsis-3: 6.0/100 hospital admissions in 2014b | ||||
| Population incidence | Traditional severe sepsis: 687/100 000 population (95% CI, 549–824) in 2015 | Traditional severe sepsis: 158/100 000 population in 2015 | |||
| Sepsis-3: 780/100 000 population (95% CI, 633–926) in 2015 |
Sepsis-3: approximately 517/100 000 populationc | ||||
| Hospital mortality | Traditional severe sepsis: 2002-35.0% 2012-18.4% |
Traditional severe sepsis: 2015-19.8% |
Traditional severe sepsisd,e: 2009-34.3% 2014-24.3% |
Traditional severe sepsis: 2010-47.8% 2015-41.7%g |
|
| Sepsis-3: 2015-17.4% |
Sepsis-3: 2000-45.5% 2012-32.1% |
Sepsis-3d,f: 2009-19.5% 2014-15.0% |
aIn accordance with the 1991 and 2001 conferences for sepsis definitions and Surviving Sepsis Campaign definitions
b30.5% of patients with sepsis-3 identified in EHR received an explicit sepsis code
cOwn calculation based on national census data
dAdjusted for hospital characteristics and case mix; calculated relative to the observed 2014 rates
eSignificant decrease from 2009 to 2014; combined outcome of death or discharge to hospice also decreased significantly from 40.3% in 2009 to 32.5% in 2014
fSignificant decrease from 2009 to 2014; no significant change in the combined outcome of death or discharge to hospice from 25.0% in 2009 to 22.5% in 2014
gRisk-adjusted mortality in 2015 was 42.1%, when assuming the same case-mix for 2015 as for 2010