The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand.

Abstract

BACKGROUND: Early goal-directed therapy might benefit patients with sepsis and septic shock in Australia and New Zealand. However, the current treatment and outcome of these patients is unknown. OBJECTIVE: To report the characteristics and outcome of patients with sepsis and septic shock presenting to hospital emergency departments (EDs) in Australia and New Zealand. SETTING: All Australian and New Zealand intensive care units contributing to the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD), 1997-2005. METHODS: Patients with an ICU admission diagnosis of nonurinary or urinary sepsis, or non-urinary or urinary sepsis with shock admitted from EDs between 1 January 1997 and 31 December 2005 were identified from the ANZICS APD. Predictor variables for hospital mortality were analysed using logistic regression. RESULTS: 7649 patients were admitted during the study period. The number of patients admitted per year increased progressively (1997, n= 368 [7.7 admissions per ICU]; 2005, n = 1409 [14.0 admissions per ICU]). Non-urinary sepsis with shock (n =3394, 44.4%) was the commonest admission diagnosis, and urinary sepsis with shock the least common (n = 607, 7.9%). Overall ICU and hospital mortality were 20.9% (n=1513/7250) and 27.6% (n=1980/7172), respectively. Hospital mortality was predicted by hospital type (tertiary, metropolitan, rural or private), patient age, APACHE III score, sepsis classification, mechanical ventilation within the first 24 hours after ICU admission, and calendar year. A significant interaction between sepsis classification and calendar year was demonstrated, with a linear decrease in mortality over time (odds ratio, 0.92; 95% CI, 0.86-0.99; P=0.02). CONCLUSIONS: The reported incidence of sepsis and septic shock in ICU patients presenting to the ED appears to have increased since 1997. In contrast, hospital mortality has decreased. These data require confirmation with a prospective cohort study.