Promoting Global Research Excellence in Severe Sepsis (PROGRESS): lessons from an international sepsis registry.
BACKGROUND
The PROGRESS Registry (Promoting Global Research Excellence in Severe Sepsis) was designed to provide comparative data reflecting everyday clinical practice, thereby allowing participating institutions to explore and benchmark medical interventions in severe sepsis.


METHODS
PROGRESS was an international, noninterventional, prospective, observational registry collecting data that describe the management and outcomes of severe sepsis patients in intensive care units (ICUs). Patients were enrolled who had been diagnosed with severe sepsis (suspected or proven infection and >or= 1 acute sepsis-induced organ dysfunction) at the participating institutions, where de-identified data were entered directly into a secured website. PROGRESS was governed by an independent international medical advisory board.


RESULTS
PROGRESS took place in 276 ICUs in 37 countries, and 12,881 patients were identified as having severe sepsis. There was considerable variation among countries in enrollment levels, provision of standard treatment and supportive therapies, and ICU and hospital outcomes. Eight countries accounted for 65.2% of the enrolled patients. Males (59.3%) and Caucasian (48.6%) patients predominated the patient cohort. Diagnosis of severe sepsis was prior to ICU admission in 45.7% of patients, at ICU admission in 29.1% of patients, and after ICU admission in the remainder. Globally, ICU and hospital mortality rates were 39.2% and 49.6%, respectively. The mean length of ICU and hospital stay was 14.6 days and 28.2 days, respectively.


CONCLUSIONS
The PROGRESS international sepsis registry demonstrates that a large web-based sepsis registry is feasible. Wide variations in outcomes and use of sepsis therapies were observed between countries. These results also suggest that additional opportunities exist across countries to improve severe sepsis outcomes.
Beale
R
R
Adult Intensive Care Unit, Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Lambeth Palace Road, SE1 7EH, London, UK. Richard.Beale@gstt.nhs.uk
Reinhart
K
K
Brunkhorst
F M
FM
Dobb
G
G
Levy
M
M
Martin
G
G
Martin
C
C
Ramsey
G
G
Silva
E
E
Vallet
B
B
Vincent
J-L
JL
Janes
J M
JM
Sarwat
S
S
Williams
M D
MD
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D019985:Benchmarking / Q000379:methods*; D015331:Cohort Studies; D003431:Cross-Cultural Comparison; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries / Q000706:statistics & numerical data*; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult