Epidemiology and economic evaluation of severe sepsis in France: age, severity, infection site, and place of acquisition (community, hospital, or intensive care unit) as determinants of workload and cost.
OBJECTIVE
Severe sepsis is a leading cause of death in critically ill patients. We evaluated cost and workload according to infection site, place and time of acquisition, and severity.


METHODS
We used a prospective 3-year database from 6 intensive care units (ICUs) including 1698 patients.


RESULTS
Of the 1698 patients, 713 (42%) had severe sepsis at admission and 339 during the ICU stay (211 had both). Mortality was twice as high in patients with than those without ICU-acquired infection, independent of the presence of severe sepsis at admission. The mean (SD; median) cost of severe sepsis was 22 800 (21 400 ; 15 800 ). Among patients with severe sepsis at admission, workload and cost were higher for pneumonia, peritonitis, and multiple-site infections and for hospital-acquired (17,400 [14,700; 17,400]) vs community-acquired infection (12,600 [12,100 ; 8900 ]). Intensive care unit-acquired severe sepsis was associated with greater than 3-fold increases in workload and costs. By multiple linear regression, older age, emergency surgery, septic shock, Acute Physiological and Chronic Health Evaluation II score, and hospital or ICU-acquired severe sepsis were independently associated with higher costs.


CONCLUSIONS
The wide variations in cost and workload invite efforts to identify patient subgroups most likely to benefit from high-cost treatments and from prevention, particularly targeting severe nosocomial infections.
Adrie
Christophe
C
Medical-Surgical ICU, Delafontaine Hospital, Saint Denis, France.
Alberti
Corinne
C
Chaix-Couturier
Carine
C
Azoulay
Elie
E
De Lassence
Arnaud
A
Cohen
Yves
Y
Meshaka
Patrick
P
Cheval
Christine
C
Thuong
Marie
M
Troché
Gilles
G
Garrouste-Orgeas
Maïté
M
Timsit
Jean-François
JF
D018806:APACHE; D017677:Age Distribution; D000368:Aged; D017714:Community-Acquired Infections / Q000191:economics / Q000453:epidemiology; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000191:economics* / Q000453:epidemiology*