Has mortality from sepsis improved and what to expect from new treatment modalities: review of current insights.
BACKGROUND
The incidence of sepsis is increasing continuously, making mortality rate reduction through improved intensive care unit (ICU) care and new treatment modalities a pressing issue. This study aimed to provide insight into the effects of modern ICU care on mortality trends from severe sepsis and to provide a quantitative review of the relative effectiveness of new treatment modalities in reducing deaths.


METHODS
Mortality data from severe sepsis were extracted from the control arms of several large randomized trials of sepsis treatment published within the last two decades. The effectiveness of recent treatment strategies was expressed as the number of patients it is necessary to treat by that method to save one life (number needed to treat: NNT).


RESULTS
Death from severe sepsis showed a decline from 44% to 35% between 1990 and 2000. The two most effective strategies in critically ill patients are early appropriate antibiotics (NNT 3; 95% confidence interval [CI] 2, 4) and early goal-directed therapy (NNT 6; 95% CI 4, 24). Infusion of recombinant human activated protein C is the most effective anticoagulant therapy (NNT 15; 95% CI 10, 27). Intensive insulin therapy is only moderately effective (NNT 27; 95% CI 15, 124).


CONCLUSIONS
The mortality rate from severe sepsis has decreased significantly with modernization of ICU care. New therapeutic strategies may reduce further the mortality rate. However, focused implementation of these new strategies in accordance with their relative effectiveness is needed before we can expect to see their true effect on mortality rates.
van Ruler
Oddeke
O
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Schultz
Marcus J
MJ
Reitsma
Johannes B
JB
Gouma
Dirk J
DJ
Boermeester
Marja A
MA
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D011486:Protein C / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D007328:Insulin; D011486:Protein C