Two Decades of Mortality Trends Among Patients With Severe Sepsis: A Comparative Meta-Analysis.

1The Pulmonary Center, Boston University School of Medicine, Boston, MA. 2Division of Pulmonary, Allergy, and Critical Care Medicine Internal Medicine, Boston Medical Center, Boston, MA. 3Department of Medicine, Boston Medical Center, Boston, MA. 4Center for Healthcare Organization & Implementation Research Edith Nourse Rogers Memorial VA Hospital, Bedford, MA. 5The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH.
Critical care medicine (Impact Factor: 6.31). 11/2013; 42(3). DOI: 10.1097/CCM.0000000000000026
Source: PubMed


Trends in severe sepsis mortality derived from administrative data may be biased by changing International Classification of Diseases, 9th Revision, Clinical Modification, coding practices. We sought to determine temporal trends in severe sepsis mortality using clinical trial data that does not rely on International Classification of Diseases, Ninth Revision, Clinical Modification coding and compare mortality trends in trial data with those observed from administrative data.
We searched MEDLINE for multicenter randomized trials that enrolled patients with severe sepsis from 1991 to 2009. We calculated standardized mortality ratios for each trial from observed 28-day mortality of usual care participants and predicted mortality from severity-of-illness scores. To compare mortality trends from clinical trials to administrative data, we identified adult severe sepsis hospitalizations in the Nationwide Inpatient Sample, 1993-2009, using two previously validated algorithms.
Patients with severe sepsis or septic shock.
Of 3,244 potentially eligible articles, we included 36 multicenter severe sepsis trials, with a total of 14,418 participants in a usual care arm. Participants with severe sepsis receiving usual care had a 28-day mortality of 33.2%. Observed mortality decreased 3.0% annually (95% CI, 0.8%-5.0%; p = 0.009), decreasing from 46.9% (standardized mortality ratio 0.94; 95% CI, 0.86-1.03) during years 1991-1995 to 29% (standardized mortality ratio 0.53; 95% CI, 0.50-0.57) during years 2006-2009 (3.0% annual change). Trends in hospital mortality among patients with severe sepsis identified from administrative data (Angus definition, 4.7% annual change; 95% CI, 4.1%-5.3%; p = 0.69 and Martin definition, 3.5% annual change; 95% CI, 3.0%-4.1%; p = 0.97) were similar to trends identified from clinical trials.
Since 1991, patients with severe sepsis enrolled in usual care arms of multicenter randomized trials have experienced decreasing mortality. The mortality trends identified in clinical trial participants appear similar to those identified using administrative data and support the use of administrative data to monitor mortality trends in patients with severe sepsis.

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    • "The survival rate of ICU patients has improved dramatically over the past several decades. [1] [2] However, up to 50% of ICU survivors go on to develop life-altering long-term cognitive impairments [3]. Delirium, an acute neuropsychiatric syndrome characterized by fluctuations in arousal and decreased awareness, attention, and cognition, is a major risk factor for post-ICU cognitive impairment, and may be prevalent in up to 75% of critically ill patients [3]. "
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    ABSTRACT: Millions of patients are admitted each year to intensive care units (ICUs) in the United States. A significant fraction of ICU survivors develop lifelong cognitive impairment, incurring tremendous financial and societal costs. Delirium, a state of impaired awareness, attention and cognition that frequently develops during ICU care, is a major risk factor for post-ICU cognitive impairment. Recent studies suggest that patients experiencing electroencephalogram (EEG) burst suppression have higher rates of mortality and are more likely to develop delirium than patients who do not experience burst suppression. Burst suppression is typically associated with coma and deep levels of anesthesia or hypothermia, and is defined clinically as an alternating pattern of high-amplitude " burst " periods interrupted by sustained low-amplitude " suppression " periods. Here we describe a clustering method to analyze EEG spectra during burst and suppression periods. We used this method to identify a set of distinct spectral patterns in the EEG during burst and suppression periods in critically ill patients. These patterns correlate with level of patient sedation, quantified in terms of sedative infusion rates and clinical sedation scores. This analysis suggests that EEG burst suppression in critically ill patients may not be a single state, but instead may reflect a plurality of states whose specific dynamics relate to a patient's underlying brain function.
    EMBC 2015; 08/2015
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    • "In the United States, sepsis is one of the top ten leading causes of mortality [4]. Although adjusted in-hospital mortality has decreased gradually (2-3% per year) according to a recent report [1] [5], sepsis associated mortality remained high, from 50/100,000 to 75/100,000 [1] [6]. It was even higher when sepsis was accompanied by organ dysfunction, ranging from 23% to 58% with dysfunction of one organ [2] [3] [7] and increasing to 77.4% when three or more organs had failure [3]. "
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    Mediators of Inflammation 06/2015; 2015:1-15. DOI:10.1155/2015/984825 · 3.24 Impact Factor
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    • "Acute organ dysfunction due to severe infection is associated with a high mortality rate [1]. The mortality rate of patients with septic shock is decreasing [2] [3], but still remains high, despite widespread adoption of international sepsis guidelines [4]. There are still several doubts about medical therapy in septic patients. "
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    Journal of Critical Care 05/2015; 30(5). DOI:10.1016/j.jcrc.2015.05.017 · 2.00 Impact Factor
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