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* From CUB-Réa (Dr. Guidet), Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris; Biostatitique (Dr. Aegerter), Hôpital Ambroise Paré, Paris; Service de Réanimation (Dr. Gauzit), Hôpital Jean Verdier, Bondy; Laboratoire Eli-Lilly (Dr. Meshaka), Suresnes; and Service de Réanimation Médicale (Dr. Dreyfuss), Hôpital Louis Mourier, Colombes, France.
Correspondence to: Bertrand Guidet, MD, Service de Réanimation Médicale, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; e-mail: bertrand.guidet{at}sat.ap-hop-paris.fr
Objective: To study the incidence and severity of organ dysfunction associated with sepsis.
Design: Comprehensive review of prospectively collected data from intensive care patients hospitalized between 1997 and 2001.
Setting: Thirty-five ICUs in nonuniversity and university hospitals located in the Paris area.
Patients: All patients hospitalized in the ICU for > 24 h meeting the criteria for severe sepsis (SS), either with only one organ dysfunction present during the ICU stay (SS1; n = 5,675) or with at least two organ dysfunction present during the ICU stay (SS2; n = 12,598), were compared to all other patients hospitalized for > 24 h in the ICU over the same time period (n = 47,637).
Interventions: None.
Measurements and main results: We collected information on demographic characteristics, type of admission, underlying disease, organ dysfunction, organ support, McCabe and Charlson-Deyo scores, simplified acute physiology score II, length of stay, and outcome. The incidence of SS was 27.7% (8.6% for SS1 and 19.1 for SS2). Compared with non-SS patients, those with SS were significantly older, were more frequently men, required organ support more frequently, had higher severity scores, and stayed longer in the ICU and hospital. Respiratory and cardiovascular dysfunction and fungal infection were strong independent risk factors for death in SS patients, with 5.64-fold, 4.35-fold, and 2.0-fold increased risks, respectively. SS2 is significantly different from SS1: older age, more surgical stays and admission from external transfer, greater number of organ supports, site of infection (less pulmonary and urinary tract infections, and more abdominal and cardiovascular infections), type of bacteria (more methicillin-resistant Staphylococcus aureus, Pseudomonas, and fungus), ICU length of stay (20.4 d vs 11.6 d), hospital length of stay (33 d vs 27.9 d), ICU mortality (42.7% vs 5.5%), and hospital mortality (49% vs 11.3%).
Conclusions: Our study identifies a subgroup of patients with an ICU stay > 24 h and SS with at least two organ dysfunctions. This group of patients requires special attention since their ICU mortality is > 40% and they occupy almost 40% of all ICU beds.
Key Words: epidemiology • infection • intensive care • organ failure • scoring systems • severe sepsis
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