One-year mortality of bloodstream infection-associated sepsis and septic shock among patients presenting to a regional critical care system.
OBJECTIVE
The long-term mortality outcome associated with sepsis and septic shock has not been well defined in a nonselected critically ill population. This study investigated the occurrence and the role of bloodstream infection (BSI) associated sepsis and septic shock at time of intensive care unit (ICU) admission on the 1-year mortality of patients admitted to a regional critical care system.


METHODS
Population-based inception cohort in all adult multidisciplinary and cardiovascular ICUs in the Calgary Health Region (population approx. 1 million) between 1 July 1999 and 31 March 2002.


METHODS
Adults (>/=18 years; n=4,845) who had at least one ICU admission to CHR ICUs.


RESULTS
In 251 (5%) patients there was BSI-associated sepsis at presentation to ICU, and 159 of these also had septic shock. The 28-day, 90-day, and 1-year mortality rates overall were 18%, 21%, and 24%: 23%, 30%, and 36% for BSI-associated sepsis without shock, and 51%, 57%, and 61% with shock, respectively. Surgical diagnosis, BSI-associated sepsis, and increasing age were independently associated with late (28-day to 1-year) mortality whereas higher APACHE II and TISS scores were associated with reduced odds in logistic regression analysis.


CONCLUSIONS
BSI-associated sepsis and septic shock are associated with increased risk of mortality persisting after 28-days up to 1 year or more. Follow-up duration beyond 28 days better defines the burden of illness associated with these syndromes.
Laupland
Kevin B
KB
Department of Critical Care Medicine, University of Calgary, 3535 Research Road NW, Calgary, AB, T2L 2K8, Canada. kevin.laupland@calgaryhealthregion.ca
Zygun
David A
DA
Doig
Christopher J
CJ
Bagshaw
Sean M
SM
Svenson
Lawrence W
LW
Fick
Gordon H
GH
D018806:APACHE; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology / Q000401:mortality*; D012772:Shock, Septic / Q000382:microbiology / Q000401:mortality*; D018709:Statistics, Nonparametric