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Results of the severe sepsis registry in intensive care units in Poland from 2003-2009
Andrzej Kübler1, Barbara Adamik, Grażyna Durek
1Chair of Anaesthesiology and Intensive Therapy, Wrocław Medical University, Poland. kai@umed.wroc.pl.
Insights
Severe sepsis is a critical condition with high mortality in Polish intensive care units (ICUs). This study found a significant decrease in sepsis-related deaths over seven years, highlighting the need for improved diagnosis and management strategies.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Severe sepsis is a leading cause of death in intensive care units (ICUs) globally.
- No prior data existed on severe sepsis prevalence in Polish ICUs.
- This study aimed to analyze the course and outcomes of severe sepsis in Poland.
Purpose of the Study:
- To analyze the incidence, characteristics, treatment, and outcomes of severe sepsis patients in Polish ICUs.
- To identify trends in severe sepsis management and mortality over a seven-year period.
- To provide data for improving sepsis diagnosis and treatment strategies in Poland.
Main Methods:
- A multicenter, observational study using an internet-based severe sepsis registry.
- Data collected via online questionnaires from participating ICUs between 2003 and 2009.
- Anonymously and voluntarily submitted data included demographics, clinical information, microbiology, treatment, and outcomes.
Main Results:
- 4999 cases of severe sepsis were registered from 2003-2009.
- Mortality rate decreased significantly from 54% in 2003 to 46% in 2009.
- Patients were critically ill, often with multi-organ dysfunction (89%), predominantly from intra-abdominal infections (49%) and community-acquired infections (53%).
- Gram-negative bacteria were the most common pathogens (58%); vasopressor use was high (86%).
Conclusions:
- Severe sepsis patients in Polish ICUs are critically ill, frequently with multi-organ dysfunction and intra-abdominal infections.
- While mortality remains high, a significant reduction was observed over the study period.
- The establishment of mandated sepsis registries in Polish hospitals is recommended to enhance sepsis management strategies.
Background:
Severe sepsis remains the most common cause of death in intensive care units (ICUs) according to many epidemiological studies. There are no data in Poland on the extent of severe sepsis cases treated in ICUs. The aim of the study was to analyse the course and outcome of severe sepsis patients treated in Polish ICUs.
Methods:
In 2003, the internet-based severe sepsis registry was created as a multicentre observational research project. An online questionnaire was made accessible to ICUs participating in the study. Questionnaires were completed after the discharge of patients and included demographic data, clinical and microbiological information about the cause, course, treatment and outcome of septic patients. All data were given voluntarily and anonymously.
Results:
During the 7-year period (2003-2009), 4999 cases of severe sepsis were registered for analysis. The mean age of septic patients was 57 years, and the majority of the patients were men (58%). The mean length of stay in the ICU was 10 days. A significant decrease in the mortality rate was observed from 54% in 2003 and 56% in 2004 to 46% in 2009 (P < 0.05). Most of the patients were admitted to the ICU for surgical reasons (56%), and intra-abdominal infections predominated (49%). Severe sepsis patients were admitted to ICUs in critical condition, and the majority of them (89%) had 3 or more organs dysfunction. The APACHE II score on admission was 26 points. Community acquired infections were the most frequent cause of severe sepsis (53%). Most of the pathogens responsible for infection were Gram-negative bacteria (58%). Gram-positive bacteria were identified in 34% of patients and fungi in 16%. A positive blood culture was detected in 41% of patients. Vasopressors were administered to most of the patients (86%). There was a marked increase in the frequency of administering noradrenaline and a decrease in administering dopamine. Renal replacement therapy was applied in 22% of the patients, and there was a marked increase in this type of therapy in the last two years of the study period.
Conclusions:
Patients with severe sepsis involved in the 7-year registry were critically ill in half of the cases because of intra-abdominal infections, and the majority of them had multi-organ dysfunction. The mortality of registered patients was high, but it significantly decreased during the observation time. Based on the results obtained from this voluntary registry, the authors conclude that mandated sepsis registries should be established in Polish hospitals to improve the strategy of diagnosing and managing this syndrome.
