Brazilian Sepsis Epidemiological Study (BASES study).
BACKGROUND
Consistent data about the incidence and outcome of sepsis in Latin American intensive care units (ICUs), including Brazil, are lacking. This study was designed to verify the actual incidence density and outcome of sepsis in Brazilian ICUs. We also assessed the association between the Consensus Conference criteria and outcome


METHODS
This is a multicenter observational cohort study performed in five private and public, mixed ICUs from two different regions of Brazil. We prospectively followed 1383 adult patients consecutively admitted to those ICUs from May 2001 to January 2002, until their discharge, 28th day of stay, or death. For all patients we collected the following data at ICU admission: age, gender, hospital and ICU admission diagnosis, APACHE II score, and associated underlying diseases. During the following days, we looked for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock criteria, as well as recording the sequential organ failure assessment score. Infection was diagnosed according to CDC criteria for nosocomial infection, and for community-acquired infection, clinical, radiological and microbiological parameters were used.


RESULTS
For the whole cohort, median age was 65.2 years (49-76), median length of stay was 2 days (1-6), and the overall 28-day mortality rate was 21.8%. Considering 1383 patients, the incidence density rates for sepsis, severe sepsis and septic shock were 61.4, 35.6 and 30.0 per 1000 patient-days, respectively. The mortality rate of patients with SIRS, sepsis, severe sepsis and septic shock increased progressively from 24.3% to 34.7%, 47.3% and 52.2%, respectively. For patients with SIRS without infection the mortality rate was 11.3%. The main source of infection was lung/respiratory tract.


CONCLUSIONS
Our preliminary data suggest that sepsis is a major public health problem in Brazilian ICUs, with an incidence density about 57 per 1000 patient-days. Moreover, there was a close association between ACCP/SCCM categories and mortality rate.
Silva
Eliézer
E
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. eliezer@einstein.br <eliezer@einstein.br>
Pedro
Marcelo de Almeida
Mde A
Sogayar
Ana Cristina Beltrami
AC
Mohovic
Tatiana
T
Silva
Carla Lika de Oliveira
CL
Janiszewski
Mariano
M
Cal
Ruy Guilherme Rodrigues
RG
de Sousa
Erica Fernandes
EF
Abe
Thereza Phitoe
TP
de Andrade
Joel
J
de Matos
Jorge Dias
JD
Rezende
Ederlon
E
Assunção
Murillo
M
Avezum
Alvaro
A
Rocha
Patrícia C S
PC
de Matos
Gustavo Faissol Janot
GF
Bento
André Moreira
AM
Corrêa
Alice Danielli
AD
Vieira
Paulo Cesar Bastos
PC
Knobel
Elias
E
D018806:APACHE; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology; D017052:Hospital Mortality; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000401:mortality; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D012772:Shock, Septic / Q000453:epidemiology / Q000401:mortality; D013030:Spain / Q000453:epidemiology; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000401:mortality