title: Epidemiology of sepsis in Catalonia: analysis of incidence and outcomes in a European setting.
abstract: BACKGROUND
  Up-to-date identification of local trends in sepsis incidence and outcomes is of considerable public health importance. The aim of our study was to estimate annual incidence rates and in-hospital mortality trends for hospitalized patients with sepsis in a European setting, while avoiding selection bias in relation to different complexity hospitals.
  
  
  METHODS
  A large retrospective analysis of a 5-year period (2008-2012) was conducted of hospital discharge records obtained from the Catalan Health System (CatSalut) Minimum Basic Data Set for Acute-Care Hospitals (a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia). Patients hospitalized with sepsis were detected on the basis of ICD-9-CM codes used to identify acute organ dysfunction and infectious processes.
  
  
  RESULTS
  Of 4,761,726 discharges from all acute-care hospitals in Catalonia, 82,300 cases (1.72%) had sepsis diagnoses. Annual incidence was 212.7 per 100,000 inhabitants/year, rising from 167.2 in 2008 to 261.8 in 2012. Length of hospital stay fell from 18.4 to 15.3 days (p < .00001), representing a relative reduction of 17%. Hospital mortality fell from 23.7 to 19.7% (p < .0001), representing a relative reduction of 16.9%. These differences were confirmed in the multivariate analysis (adjusted for age group, sex, comorbidities, ICU admission, emergency admission, organ dysfunction, number of organ failures, sepsis source and bacteraemia).
  
  
  CONCLUSIONS
  Sepsis incidence has risen in recent years, whereas mortality has fallen. Our findings confirm reports for other parts of the world, in the context of scarce administrative data on sepsis in Europe.
authors.affiliation: Critical Care Department, Hospital de Mataró, Mataró, Spain. jyebenes@csdm.cat.|Grup de Recerca en Sepsis, Imflamació i Seguretat (AGAUR 2014-SGR926), Barcelona, Spain. jyebenes@csdm.cat.|Escola Superior de Ciencies de la Salut, Universitat Pompeu Fabra, Mataró, Spain. jyebenes@csdm.cat.|Servei de Medicina Intensiva, Hospital de Mataró, Carretera de Cirera s/n, 08304, Mataró, Spain. jyebenes@csdm.cat.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Yébenes
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.|Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d' Hebron Research Institut, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Ruiz-Rodriguez
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.|Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d' Hebron Research Institut, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBER Enfermedades Respiratorias, Madrid, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Ferrer
authors.affiliation: Divisió d'Anàlisi de la Demanda i l'Activitat, Servei Català de la Salut (CatSalut), Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Clèries
authors.affiliation: Divisió d'Anàlisi de la Demanda i l'Activitat, Servei Català de la Salut (CatSalut), Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Bosch
authors.affiliation: Critical Care Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain.
authors.forename: Carol
authors.initials: C
authors.lastname: Lorencio
authors.affiliation: Grup de Recerca en Sepsis, Imflamació i Seguretat (AGAUR 2014-SGR926), Barcelona, Spain.|Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain.|IISPV/URV, Tarragona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: Critical Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.|Institut de Recerca Biomèdica (IRB), Lleida, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Nuvials
authors.affiliation: Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.affiliation: CIBER Enfermedades Respiratorias, Madrid, Spain.|Critical Care Center, Sabadell Hospital, Corporació Sanitaria Universitaria Parc Tauli, Sabadell, Spain.|Universitat Autonoma de Barcelona, Sabadell, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Artigas
keywords: Epidemiology; Mortality; Sepsis; Septic shock