Richard T. Ellison III, MD

A review of intensive care unit admissions in Australia and New Zealand shows a marked decrease in mortality from severe sepsis.

The last decade has seen numerous changes in the management of severe sepsis, including the tracking of serum lactate levels, aggressive fluid resuscitation, and prompt initiation of effective antibiotic therapy. However, the clinical effects of these measures have not been well defined. To address this issue, researchers used the Australian and New Zealand Intensive Care Society adult intensive care unit (ICU) patient database to analyze hospital outcomes of patients admitted with severe sepsis to any of 171 ICUs between 2000 and 2012.

Among 1,037,115 patients treated in these ICUs during the 13-year study period, 101,064 (9.7%) had severe sepsis. The proportion of ICU patients with severe sepsis progressively increased, from 7.2% in 2000 to 11.1% in 2012. The adjusted hospital mortality for these patients progressively declined each year (odds ratio in 2012 compared with 2000, 0.49; 95% confidence interval, 0.46–0.52), and the decrease applied over the full course of the hospital stay. Hospital mortality decreased similarly for nonsepsis ICU patients; however, compared with nonsepsis patients, those with severe sepsis were progressively more likely to be discharged home and less likely to be discharged to a rehabilitation facility.

Citation(s):

Kaukonen K-M et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014 Apr 2; 311:1308.

Iwashyna TJ and Angus DC.Declining case fatality rates for severe sepsis: Good data bring good news with ambiguous implications. JAMA 2014 Apr 2; 311:1295.