title: Epidemiology of severe sepsis in Japanese intensive care units: a prospective multicenter study.
abstract: Severe sepsis is a leading cause of morbidity and mortality in the intensive care unit (ICU). We conducted a prospective multicenter study to evaluate epidemiology and outcome of severe sepsis in Japanese ICUs. The patients were registered at 15 general critical care centers in Japanese tertiary care hospitals when diagnosed as having severe sepsis. Of 14,417 patients, 624 (4.3%) were diagnosed with severe sepsis. Demographic and clinical characteristics at enrollment (Day 1), physiologic and blood variables on Days 1 and 4, and mortality were evaluated. Mean age was 69.0 years, and initial mean Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were 23.4 and 8.6, respectively. The 28-day mortality was 23.1%, and overall hospital mortality was 29.5%. SOFA score and disseminated intravascular coagulation (DIC) score were consistently higher in nonsurvivors than survivors on Days 1 and 4. SOFA score, DIC score on Days 1 and 4, and hospital mortality were higher in patients with than without septic shock. SOFA score on Days 1 and 4 and hospital mortality were higher in patients with than without DIC. Logistic regression analyses showed age, presence of septic shock, DIC, and cardiovascular dysfunction at enrollment to be predictors of 28-day mortality and presence of comorbidity to be an additional predictor of hospital mortality. Presence of septic shock or DIC resulted in approximately twice the mortality of patients without each factor, whereas the presence of comorbidity may be a significant predictor of delayed mortality in severe sepsis.
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: ogura@hp-emerg.med.osaka-u.ac.jp.
authors: Hiroshi
authors: H
authors: Ogura
authors: Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Kita 2 jou Nishi 5, Kitaku, Sapporo, Hokkaido 060-8638, Japan.
authors: Satoshi
authors: S
authors: Gando
authors: Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
authors: Daizoh
authors: D
authors: Saitoh
authors: Department of Emergency and Acute Intensive Care Medicine, Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
authors: Naoshi
authors: N
authors: Takeyama
authors: Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Seiryoumachi 2-1, Aobaku, Sendai, Miyagi 980-8575, Japan.
authors: Shigeki
authors: S
authors: Kushimoto
authors: Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan.
authors: Seitaro
authors: S
authors: Fujishima
authors: Emergency Center, Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Bunkyo 2-2-22, Ichinomiya, Aichi 491-8558, Japan.
authors: Toshihiko
authors: T
authors: Mayumi
authors: Department of Emergency & Critical Care Medicine, Trauma Center St. Mary's Hospital, Tsubukuhonmachi 422, Kurume, Fukuoka 830-8543, Japan.
authors: Tsunetoshi
authors: T
authors: Araki
authors: Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 173-8606, Japan.
authors: Hiroto
authors: H
authors: Ikeda
authors: Department of Emergency, Critical Care and Disaster Medicine, Hyogo College of Medicine, Mukogawa 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Joji
authors: J
authors: Kotani
authors: Advanced Critical Care Center, Aichi Medical University Hospital, Yazakokarimata 1-1, Nagakute, Aichi 480-1195, Japan.
authors: Yasuo
authors: Y
authors: Miki
authors: Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi 1-1-5, Bunkyou-ku, Tokyo 113-8603, Japan.
authors: Shin-Ichiro
authors: S
authors: Shiraishi
authors: Department of Acute Medicine, Kawasaki Medical School, Matsushima 577, Kurashiki, Okayama 701-0114, Japan.
authors: Koichiro
authors: K
authors: Suzuki
authors: Department of Critical Care Medicine, Iwate Medical University, Uchimaru 19-1, Morioka, Iwate 020-8505, Japan.
authors: Yasushi
authors: Y
authors: Suzuki
authors: Emergency & Critical Care Center, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan.
authors: Kiyotsugu
authors: K
authors: Takuma
authors: Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Minamikogushi 1-1-1, Ube, Yamaguchi 755-8505, Japan.
authors: Ryosuke
authors: R
authors: Tsuruta
authors: Department of Trauma & Critical Care Medicine, Kyorin University, School of Medicine, Shinkawa 6-20-2, Mitaka, Tokyo 181-8611, Japan.
authors: Yoshihiro
authors: Y
authors: Yamaguchi
authors: Department of Emergency & Critical Care Medicine, School of Medicine, Kurume University, Asahimachi 67, Kurume, Fukuoka 830-0011, Japan.
authors: Norio
authors: N
authors: Yamashita
authors: Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan.
authors: Naoki
authors: N
authors: Aikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: DIC; Epidemiology; Japan; Outcome; Septic shock; Severe sepsis