Chest
Volume 140, Issue 5, November 2011, Pages 1223-1231
Journal home page for Chest

Original Research
Critical Care
Nationwide Trends of Severe Sepsis in the 21st Century (2000–2007)

https://doi.org/10.1378/chest.11-0352Get rights and content

Background

Severe sepsis is common and often fatal. The expanding armamentarium of evidence-based therapies has improved the outcomes of persons with this disease. However, the existing national estimates of the frequency and outcomes of severe sepsis were made before many of the recent therapeutic advances. Therefore, it is important to study the outcomes of this disease in an aging US population with rising comorbidities.

Methods

We used the Healthcare Costs and Utilization Project's Nationwide Inpatient Sample (NIS) to estimate the frequency and outcomes of severe sepsis hospitalizations between 2000 and 2007. We identified hospitalizations for severe sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating the presence of sepsis and organ system failure. Using weights from NIS, we estimated the number of hospitalizations for severe sepsis in each year. We combined these with census data to determine the number of severe sepsis hospitalizations per 100,000 persons. We used discharge status to identify in-hospital mortality and compared mortality rates in 2000 with those in 2007 after adjusting for demographics, number of organ systems failing, and presence of comorbid conditions.

Results

The number of severe sepsis hospitalizations per 100,000 persons increased from 143 in 2000 to 343 in 2007. The mean number of organ system failures during admission increased from 1.6 to 1.9 (P < .001). The mean length of hospital stay decreased from 17.3 to 14.9 days. The mortality rate decreased from 39% to 27%. However, more admissions ended with discharge to a long-term care facility in 2007 than in 2000 (35% vs 27%, P < .001).

Conclusions

An increasing number of admissions for severe sepsis combined with declining mortality rates contribute to more individuals surviving to hospital discharge. Importantly, this leads to more survivors being discharged to skilled nursing facilities and home with in-home care. Increased attention to this phenomenon is warranted.

Section snippets

Data Source

NIS is the largest all-payer inpatient-care database publicly available in the United States. It is an administrative data set created by the Agency for Healthcare Research and Quality from data contributed by participating states. During the study years, it contained data on 5 to 8 million hospital stays from about 1,000 hospitals sampled to approximate a 20% sample of US community hospitals, defined by the American Hospital Association to be “all non-Federal, short-term, general, and other

Results

The annual number of discharges with severe sepsis increased from 300,270 (0.99% of all hospitalizations) in 2000 to 781,725 (2.38% of all hospitalizations) in 2007, amounting to a 160% increase over the span of the study period (e-Fig 1, Fig 1). The frequency of hospitalizations with severe sepsis increased from 143 per 100,000 US adults in 2000 to 343 per 100,000 in 2007, an average annual increase of 16.5%. As shown in Figure 2, the increase was quite consistent throughout this period and

Discussion

We have demonstrated that the increases in the frequency of severe sepsis through 2000 documented by others have continued, and even accelerated, during the period from 2000 to 2007 (e-Table 6). Moreover, despite remarkable improvements in severity-adjusted mortality during this time frame, the marked increase in hospitalizations has led to a continued striking increase in the number of deaths associated with severe sepsis. Similar trends were observed for septic shock, where the incidence

Conclusions

Despite its limitations, our study provides an important extension of prior work and suggests future directions for research and policy. It reiterates prior warnings that severe sepsis is an increasingly important contributor to hospitalizations, hospital deaths, and, importantly, discharges to SNF. Policy-makers and health-care systems must be ready to meet the needs of this population. Specifically, there is a need to identify approaches that can help the growing cohort of persons discharged

Acknowledgments

Author contributions: Dr Nanchal had full access to the data and vouches for its integrity.

Dr G. Kumar: contributed to the study design, statistical analysis, and writing of the manuscript.

Dr N. Kumar: contributed to the critical review and revision of the manuscript.

Dr Taneja: contributed to the critical review and revision of the manuscript.

Dr Kaleekal: contributed to the critical review and revision of the manuscript.

Dr Tarima: contributed to the statistical analysis and revision of the

References (30)

  • RC Bone et al.

    Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis

    Chest

    (1992)
  • RMJ Bohmer et al.

    The effect of decreasing length of stay on discharge destination and readmission after coronary bypass operation

    Surgery

    (2002)
  • MD Wong et al.

    Contribution of major diseases to disparities in mortality

    N Engl J Med

    (2002)
  • GR Bernard et al.

    Efficacy and safety of recombinant human activated protein C for severe sepsis

    N Engl J Med

    (2001)
  • G van den Berghe et al.

    Intensive insulin therapy in the critically ill patients

    N Engl J Med

    (2001)
  • CL Sprung et al.

    Hydrocortisone therapy for patients with septic shock

    N Engl J Med

    (2008)
  • E Rivers et al.

    Early goal-directed therapy in the treatment of severe sepsis and septic shock

    N Engl J Med

    (2001)
  • The Acute Respiratory Distress Syndrome Network

    Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome

    N Engl J Med

    (2000)
  • JP Kress et al.

    Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation

    N Engl J Med

    (2000)
  • S Finfer et al.

    Intensive versus conventional glucose control in critically ill patients

    N Engl J Med

    (2009)
  • D Annane et al.

    Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock [published correction appears in JAMA. 2008;300(14):1652]

    JAMA

    (2002)
  • R Bellomo et al.

    Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial

    Lancet

    (2000)
  • MO Meade et al.

    Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial

    JAMA

    (2008)
  • DA Harrison et al.

    The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database

    Crit Care

    (2006)
  • KE Sands et al.

    Epidemiology of sepsis syndrome in 8 academic medical centers

    JAMA

    (1997)
  • Cited by (520)

    • Society for Maternal-Fetal Medicine Consult Series #67: Maternal sepsis

      2023, American Journal of Obstetrics and Gynecology
    View all citing articles on Scopus

    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

    View full text