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Severe sepsis mortality rates decreased in Australia, New Zealand
In New Zealand and Australia, the mortality rate of critically ill patients with sepsis decreased from 2000 to 2012, according to recent findings published in JAMA.
This decrease, which was seen in patients with and without septic shock, was consistent with changes in hospital discharge patterns.
In the retrospective, observational study, Kirsi-Maija Kaukonen, MD, PhD, of the Australian and New Zealand Intensive Care Research Centre, and colleagues utilized data on 101,064 patients with severe sepsis gleaned from the Australian and New Zealand Intensive Care Society adult ICU patient database. All patients were seen at one of 171 ICUs with varying patient case mix between 2000 and 2012. The researchers evaluated all hospital outcomes, including mortality, discharge to home, discharge to other hospital and discharge to rehabilitation. Also included for comparison were estimated trends in outcome for all other patients in the adult patient database; mean age of patients was 64 years.
The investigators found a decrease in severe sepsis absolute mortality, from 35% (95% CI, 33.2-36.8; 949/2,708) to 18.4% (95% CI, 17.8-19; 2,300/12,512), which signified an overall decrease of 16.7% (95% CI, 14.8-18.6), an annual rate of absolute decrease of 1.3% and a RR reduction of 47.5% (95% CI, 44.1-50.8). Mortality was further decreased after adjustment for various confounders, with an OR of 0.49 (95% CI, 0.46-0.52) in 2012, using 2000 as the reference (P<.001).
There was no significant difference in the annual mortality decrease between severe sepsis patients and those with all other diagnoses. However, there was a significantly greater annual increase in the rates of discharge to home in patients with severe sepsis compared with all other diagnoses (OR=1.03; 95% CI, 1.02-1.03 vs. 1.01; 95% CI, 1.01-1.01).
Moreover, the yearly increase in the rate of discharge-to-rehabilitation facilities was significantly lower in the severe sepsis patients compared with all other diagnoses (OR=1.08; 95% CI, 1.07-1.09 vs. 1.09; 95% CI, 1.09-1.10).
After adjusting for comorbidities and older age, there was a less than 5% mortality rate in severe sepsis patients.
“Although no single explanation can be offered for our findings, they challenge the view that little progress has been made in the management of severe sepsis,” the researchers wrote. “They also suggest that outcomes for severe sepsis should be interpreted according to the year of data collection and that, on average, a yearly 1% improvement in in crude mortality can be expected.”
Disclosure: Kaukonen reported receipt of a grant for clinical research career from the Academy of Finland.