A prospective, observational registry of patients with severe sepsis: the Canadian Sepsis Treatment and Response Registry.
OBJECTIVE
To determine the location of acquisition, timing, and outcomes associated with severe sepsis in community and teaching hospital critical care units.


METHODS
Prospective, observational study.


METHODS
Twelve Canadian community and teaching hospital critical care units.


METHODS
All patients admitted between March 17, 2003, and November 30, 2004 to the study critical care units with at least a 24-hr length of stay or severe sepsis identified during the first 24 hrs.


METHODS
Daily monitoring for severe sepsis.


RESULTS
We recorded data describing characteristics of patients, infections, systemic responses, and organ dysfunction. Severe sepsis occurred in 1238 patients (overall rate, 19.0%; range, 8.2%-35.3%). Hospital mortality was 38.1% (95% confidence interval [CI]: 35.4-40.8). Median intensive care unit length of stay was 10.3 days (interquartile range: 5.5, 17.9). Variables associated with mortality in multivariable analysis included age (odds ratio [OR] by decade 1.50; 95% CI: 1.36-1.65), acquisition location of severe sepsis (with community as the reference-hospital [OR: 1.69; CI: 1.16-2.46], early intensive care unit [OR: 2.15; CI: 1.42-3.25], late intensive care unit [OR: 2.65; CI: 1.82-3.87]), late intensive care unit (OR: 2.65; CI: 1.82-3.87), any comorbidity (OR: 1.42; CI: 1.04-1.93), chronic renal failure (OR: 2.03; CI: 1.10-3.76), oliguria (OR: 1.34; CI: 1.02-1.76), thrombocytopenia (OR: 2.12; CI: 1.43-3.13), metabolic acidosis (OR: 1.54; CI: 1.13-2.10), Multiple Organ Dysfunction Score (OR: 1.15; CI: 1.09-1.21) and Acute Physiology and Chronic Health Evaluation II predicted risk (OR: 3.75; CI: 2.08-6.76).


CONCLUSIONS
These data confirm that sepsis is common and has high mortality in general intensive care unit populations. Our results can inform healthcare system planning and clinical study designs. Modifiable variables associated with worse outcomes, such as nosocomial infection (hospital acquisition), and metabolic acidosis indicate potential targets for quality improvement initiatives that could decrease mortality and morbidity.
Martin
Claudio M
CM
London Health Sciences Centre, Lawson Health Research Institute, London, Canada. claudio_m_martin@hotmail.com
Priestap
Fran
F
Fisher
Harold
H
Fowler
Robert A
RA
Heyland
Daren K
DK
Keenan
Sean P
SP
Longo
Christopher J
CJ
Morrison
Teresa
T
Bentley
Diane
D
Antman
Neil
N
D002170:Canada; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D018805:Sepsis / Q000453:epidemiology*; D012720:Severity of Illness Index