title: Nationwide trends of severe sepsis in the 21st century (2000-2007).
abstract: BACKGROUND
  Severe sepsis is common and often fatal. The expanding armamentarium of evidence-based therapies has improved the outcomes of persons with this disease. However, the existing national estimates of the frequency and outcomes of severe sepsis were made before many of the recent therapeutic advances. Therefore, it is important to study the outcomes of this disease in an aging US population with rising comorbidities.
  
  
  METHODS
  We used the Healthcare Costs and Utilization Project's Nationwide Inpatient Sample (NIS) to estimate the frequency and outcomes of severe sepsis hospitalizations between 2000 and 2007. We identified hospitalizations for severe sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating the presence of sepsis and organ system failure. Using weights from NIS, we estimated the number of hospitalizations for severe sepsis in each year. We combined these with census data to determine the number of severe sepsis hospitalizations per 100,000 persons. We used discharge status to identify in-hospital mortality and compared mortality rates in 2000 with those in 2007 after adjusting for demographics, number of organ systems failing, and presence of comorbid conditions.
  
  
  RESULTS
  The number of severe sepsis hospitalizations per 100,000 persons increased from 143 in 2000 to 343 in 2007. The mean number of organ system failures during admission increased from 1.6 to 1.9 (P < .001). The mean length of hospital stay decreased from 17.3 to 14.9 days. The mortality rate decreased from 39% to 27%. However, more admissions ended with discharge to a long-term care facility in 2007 than in 2000 (35% vs 27%, P < .001).
  
  
  CONCLUSIONS
  An increasing number of admissions for severe sepsis combined with declining mortality rates contribute to more individuals surviving to hospital discharge. Importantly, this leads to more survivors being discharged to skilled nursing facilities and home with in-home care. Increased attention to this phenomenon is warranted.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Gagan
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI.
authors.forename: Nilay
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Amit
authors.initials: A
authors.lastname: Taneja
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kaleekal
authors.affiliation: Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Sergey
authors.initials: S
authors.lastname: Tarima
authors.affiliation: Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Emily
authors.initials: E
authors.lastname: McGinley
authors.affiliation: Department of Critical Care Medicine, Orlando Regional Medical Center, Orlando, FL.
authors.forename: Edgar
authors.initials: E
authors.lastname: Jimenez
authors.affiliation: Department of Critical Care Medicine, Orlando Regional Medical Center, Orlando, FL.
authors.forename: Anand
authors.initials: A
authors.lastname: Mohan
authors.affiliation: Department of Critical Care Medicine, Orlando Regional Medical Center, Orlando, FL.
authors.forename: Rumi Ahmed
authors.initials: RA
authors.lastname: Khan
authors.affiliation: Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI.
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jacobs
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI. Electronic address: rnanchal@mcw.edu.
authors.forename: Rahul
authors.initials: R
authors.lastname: Nanchal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology