title: The direct costs of intensive care management and risk factors for financial burden of patients with severe sepsis and septic shock.
abstract: OBJECTIVE
  The costs of severe sepsis care from middle-income countries are lacking. This study investigated direct intensive care unit (ICU) costs and factors that could affect the financial outcomes.
  
  
  METHODS
  A prospective cohort study was conducted in the medical ICU of a tertiary referral university teaching hospital in Thailand.
  
  
  RESULTS
  A total of 897 patients were enrolled in the study, with 683 (76.1%) having septic shock. Community-, nosocomial, and ICU-acquired infections were documented in 574, 282, and 41 patients, respectively. The median ICU costs per patient were $2716.5 ($1296.1-$5367.6) and $599.9 ($414.3-$948.6) per day. The ICU costs accounted for 64.7% of the hospital costs. In 2008 to 2011, the ICU costs significantly decreased by 40% from $3542.5 to $2124.9, whereas, the daily ICU costs decreased only 3.3% from $609.7 to $589.7. By multivariate logistic regression analysis, age, nosocomial or ICU infection, admission from the emergency department, number of organ failures, ICU length of stay, and fluid balance the first 72 hours were independently associated with ICU costs.
  
  
  CONCLUSIONS
  The ICU costs of severe sepsis management significantly declined in our study. However, the ICU costs were a financial burden accounting for two thirds of the hospital costs. It is essential for intensivists to contribute a high standard of care within a restricted budget.
authors.affiliation: Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. Electronic address: kbordin@medicine.psu.ac.th.
authors.forename: Bodin
authors.initials: B
authors.lastname: Khwannimit
authors.affiliation: Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
authors.forename: Rungsun
authors.initials: R
authors.lastname: Bhurayanontachai
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000191:economics*; D003428:Cross Infection / Q000191:economics; D004180:Direct Service Costs; D004636:Emergency Service, Hospital; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000191:economics*; D012772:Shock, Septic / Q000150:complications / Q000191:economics
keywords: Costs; Intensive care; Septic shock; Severe sepsis