title: Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study.
abstract: BACKGROUND
  Sepsis is a leading cause of admission to non-cardiological intensive care units (ICUs) and the second leading cause of death among ICU patients. We present the first extensive dataset on the epidemiology of severe sepsis treated in ICUs in Spain.
  
  
  METHODS
  We conducted a prospective, observational, multicentre cohort study, carried out over two 3-month periods in 2002. Our aims were to determine the incidence of severe sepsis among adults in ICUs in a specific area in Spain, to determine the early (48 h) ICU and hospital mortality rates, as well as factors associated with the risk of death.
  
  
  RESULTS
  A total of 4,317 patients were admitted and 2,619 patients were eligible for the study; 311 (11.9%) of these presented at least 1 episode of severe sepsis, and 324 (12.4%) episodes of severe sepsis were recorded. The estimated accumulated incidence for the population was 25 cases of severe sepsis attended in ICUs per 100,000 inhabitants per year. The mean logistic organ dysfunction system (LODS) upon admission was 6.3; the mean sepsis-related organ failure assessment (SOFA) score on the first day was 9.6. Two or more organ failures were present at diagnosis in 78.1% of the patients. A microbiological diagnosis of the infection was reached in 209 episodes of sepsis (64.5%) and the most common clinical diagnosis was pneumonia (42.8%). A total of 169 patients (54.3%) died in hospital, 150 (48.2%) of these in the ICU. The mortality in the first 48 h was 14.8%. Factors associated with early death were haematological failure and liver failure at diagnosis, acquisition of the infection prior to ICU admission, and total LODS score on admission. Factors associated with death in the hospital were age, chronic alcohol abuse, increased McCabe score, higher LODS on admission, DeltaSOFA 3-1 (defined as the difference in the total SOFA scores on day 3 and on day 1), and the difference of the area under the curve of the SOFA score throughout the first 15 days.
  
  
  CONCLUSIONS
  We found a high incidence of severe sepsis attended in the ICU and high ICU and hospital mortality rates. The high prevalence of multiple organ failure at diagnosis and the high mortality in the first 48 h suggests delays in diagnosis, in initial resuscitation, and/or in initiating appropriate antibiotic treatment.
authors.affiliation: Critical Care Department, Nuevo Hospital Universitario Río Hortega, Calle Dulzaina s/n, 47012 Valladolid, Spain. jblanco@hurh.sacyl.es
authors.forename: Jesús
authors.initials: J
authors.lastname: Blanco
authors.forename: Arturo
authors.initials: A
authors.lastname: Muriel-Bombín
authors.forename: Víctor
authors.initials: V
authors.lastname: Sagredo
authors.forename: Francisco
authors.initials: F
authors.lastname: Taboada
authors.forename: Francisco
authors.initials: F
authors.lastname: Gandía
authors.forename: Luís
authors.initials: L
authors.lastname: Tamayo
authors.forename: Javier
authors.initials: J
authors.lastname: Collado
authors.forename: Angel
authors.initials: A
authors.lastname: García-Labattut
authors.forename: Demetrio
authors.initials: D
authors.lastname: Carriedo
authors.forename: Manuel
authors.initials: M
authors.lastname: Valledor
authors.forename: Martín
authors.initials: M
authors.lastname: De Frutos
authors.forename: María-Jesús
authors.initials: MJ
authors.lastname: López
authors.forename: Ana
authors.initials: A
authors.lastname: Caballero
authors.forename: José
authors.initials: J
authors.lastname: Guerra
authors.forename: Braulio
authors.initials: B
authors.lastname: Alvarez
authors.forename: Agustín
authors.initials: A
authors.lastname: Mayo
authors.forename: Jesús
authors.initials: J
authors.lastname: Villar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006764:Hospitals, Community; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality*; D019370:Observation; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality* / Q000503:physiopathology; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology