title: Declining mortality due to severe sepsis and septic shock in Spanish intensive care units: A two-cohort study in 2005 and 2011.
abstract: OBJECTIVE
  To analyze the evolution of sepsis-related mortality in Spanish Intensive Care Units (ICUs) following introduction of the Surviving Sepsis Campaign (SSC) guidelines and the relationship with sepsis process-of-care.
  
  
  METHODS
  A prospective cohort study was carried out, with the inclusion of all consecutive patients presenting severe sepsis or septic shock admitted to 41 Spanish ICUs during two time periods: 2005 (Edusepsis study pre-intervention group) and 2011 (ABISS-Edusepsis study pre-intervention group).
  
  
  METHODS
  Patients with severe sepsis or septic shock admitted to Spanish ICUs.
  
  
  METHODS
  All ICU admissions from the emergency department or wards and all ICU patients with a diagnosis of severe sepsis or septic shock. A total of 1348 patients were included: 630 in the 2005 group and 718 in the 2011 group.
  
  
  METHODS
  None.
  
  
  METHODS
  ICU mortality, 28-day mortality and Hospital mortality, hospital length of stay, ICU length of stay and compliance with the resuscitation bundle.
  
  
  RESULTS
  Compliance with the resuscitation bundle was significantly greater in the 2011 group (5.7% vs. 9.9%; p=0.005), and was associated to lower mortality (OR 0.602 [0.365-0.994]; p=0.048). The 2011 group had lower absolute in-hospital mortality (44.0% vs. 32.6%; p=0.01), 28-day mortality (36.5% vs. 23.0%; p=0.01), and adjusted mortality (OR 0.64 [0.49-0.83], p=0.001).
  
  
  CONCLUSIONS
  Mortality related to severe sepsis or septic shock in Spain decreased between two patient cohorts in 2005 and 2011, and was attributable to earliness and improvement in sepsis care.
authors.affiliation: Intensive Care Department, Hospital Universitari Mútua Terrassa, PhD Programme, University of Barcelona, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Sánchez
authors.affiliation: Intensive Care Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias, Spain; Shock, organ dysfunction and Resuscitation Research Group (SODIR), VHIR, Barcelona, Spain. Electronic address: r.ferrer@vhebron.net.
authors.forename: R
authors.initials: R
authors.lastname: Ferrer
authors.affiliation: Epidemiology and Assessment Unit, Fundació Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Suarez
authors.affiliation: Intensive Care Department, Hospital Universitari Mútua Terrassa, PhD Programme, University of Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Romay
authors.affiliation: Intensive Care Department, Hospital Universitari Mútua Terrassa, PhD Programme, University of Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Piacentini
authors.affiliation: CIBER Enfermedades Respiratorias, Spain; Critical Care Centre, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Gomà
authors.affiliation: CIBER Enfermedades Respiratorias, Spain; Critical Care Centre, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Martínez
authors.affiliation: CIBER Enfermedades Respiratorias, Spain; Critical Care Centre, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Artigas
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence; D006293:Health Promotion; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D064872:Patient Care Bundles; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000401:mortality*; D012772:Shock, Septic / Q000150:complications / Q000401:mortality; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
keywords: Critical care; Guidelines; Guías; Medicina intensiva; Mortalidad; Mortality; Sepsis