title: Incidence and long-term outcome of sepsis on general wards and in an ICU at the General Hospital of Vienna: an observational cohort study.
abstract: Sepsis is one of the leading causes of death in intensive care units (ICUs) and has enormous relevance in health economics. There is growing evidence, however, that a significant percentage of patients with sepsis are not treated in an ICU. The aim of this study was to describe the epidemiology and short- and long-term mortality of sepsis according to patients' location on general wards or in an ICU over a period of a year. We retrospectively collected data on patients with sepsis admitted to the General Hospital of Vienna during a 12-month period. We used world health organization (WHO) ICD-10 classification as the selection criterion and analyzed demographic data, length of stay, and 28-day, hospital, and 3-year mortality on general wards and in the ICU. A total of 68,305 inpatient admission episodes between January 1 and December 31, 2007 were screened for sepsis. Using ICD-10 codes we identified 139 patients with sepsis, giving a cumulative hospital incidence of 2 cases/1,000 admissions; 32 % of these patients needed ICU treatment. The overall 28-day mortality rate was 29.5 %, increasing to 55.4 % 3 years after hospital discharge. On general wards the 28-day mortality rate was 12.6 %, increasing to 42.1 % 3 years after discharge; the respective rates for the ICU were 65.9 and 84.1 %. Sepsis is a disease of predominantly elderly patients. The majority of sepsis occurred on general wards and about 30 % in the ICU. Considerable number of patients with sepsis on general wards died after hospital discharge, thus the often used 28-day in-hospital mortality rate may fail to capture the true impact of sepsis on subsequent outcome.
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stiermaier
authors.forename: Harald
authors.initials: H
authors.lastname: Herkner
authors.forename: Selma
authors.initials: S
authors.lastname: Tobudic
authors.forename: Karin
authors.initials: K
authors.lastname: Burgmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
authors.forename: Peter
authors.initials: P
authors.lastname: Schellongowski
authors.forename: Heinz
authors.initials: H
authors.lastname: Burgmann
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate