title: Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit.
abstract: BACKGROUND
  Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality.
  
  
  METHODS
  730 participating centres in 84 countries prospectively collected data on all adult (>16 years) patients admitted to their ICU between May 8 and May 18, 2012, except those admitted for fewer than 24 h for routine postoperative monitoring. Participation was voluntary. Data were collected daily for a maximum of 28 days in the ICU and patients were followed up for outcome data until death or hospital discharge. In-hospital death was analysed using multilevel logistic regression with three levels: patient, hospital, and country.
  
  
  RESULTS
  10,069 patients were included from ICUs in Europe (5445 patients; 54·1%), Asia (1928; 19·2%), the Americas (1723; 17·1%), Oceania (439; 4·4%), the Middle East (393; 3·9%), and Africa (141; 1·4%). Overall, 2973 patients (29·5%) had sepsis on admission or during the ICU stay. ICU mortality rates were 16·2% (95% CI 15·5-16·9) across the whole population and 25·8% (24·2-27·4) in patients with sepsis. Hospital mortality rates were 22·4% (21·6-23·2) in the whole population and 35·3% (33·5-37·1) in patients with sepsis. Using a multilevel analysis, the unconditional model suggested significant between-country variations (var=0·19, p=0·002) and between-hospital variations (var=0·43, p<0·0001) in the individual risk of in-hospital death. There was a stepwise increase in the adjusted risk of in-hospital death according to decrease in global national income.
  
  
  CONCLUSIONS
  This large database highlights that sepsis remains a major health problem worldwide, associated with high mortality rates in all countries. Our findings also show a significant association between the risk of death and the global national income and suggest that ICU organisation has an important effect on risk of death.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: jlvincen@ulb.ac.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Department of Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, St Michael's Hospital, Toronto, ON, Canada.
authors.forename: John C
authors.initials: JC
authors.lastname: Marshall
authors.affiliation: Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico.
authors.forename: Silvio A
authors.initials: SA
authors.lastname: Namendys-Silva
authors.affiliation: Service de Réanimation Polyvalente, CHU Dupuytren, Limoges cedex, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.affiliation: Critical Care Centre, Corporació Sanitària I Universitaria Parc Taulí-Hospital De Sabadell, Institut Universitari Uab, Ciber Enfermedades Respiratorias, Sabadell, Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.affiliation: Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, University of Queensland, QLD, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.affiliation: Department of Anaesthesiology and Intensive Care and Centre for Sepsis Care and Control, Jena University Hospital, Jena, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.affiliation: Department of Anaesthesiology and Intensive Care, Catholic University-Policlinico A Gemelli University Hospital, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.affiliation: Department of Intensive Care, Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Hassane
authors.initials: H
authors.lastname: Njimi
authors.affiliation: Department of Critical Care, Orlando Regional Medical Center, Orlando, FL, USA.
authors.forename: Edgar
authors.initials: E
authors.lastname: Jimenez
authors.affiliation: Department of Anaesthesiology and Intensive Care and Centre for Sepsis Care and Control, Jena University Hospital, Jena, Germany.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality*; D014943:Global Health; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D018805:Sepsis / Q000401:mortality*