An observational study of community‐acquired severe sepsis comparing intensive care and non‐intensive care patients. Issue 2 (6th January 2017)

• Record Type: Journal Article
• Authors: Nygård, S. T.; Skrede, S.; Langeland, N.; Flaatten, H. K.
• Is Part Of: Acta anaesthesiologica scandinavica. Volume 61:Issue 2(2017:Feb.)
• Page Start: 194
• Page End: 204
• Publication Date: 2017-01-06
• Subjects: Anesthesiology -- Periodicals; Critical care medicine -- Periodicals; 617.9605
• DOI: 10.1111/aas.12848
• Languages: English
• ISSNs: 0001-5172

Abstract

Abstract : Background: Most studies of sepsis are from intensive care units (ICUs). We aimed to investigate community‐acquired severe sepsis in a broader population, in order to compare patients treated in or outside an ICU . Methods: We performed a 1‐year prospective observational study with enrollment of patients from three units; a general ICU, a combined ICU/non‐ICU and a medical ward with limited surveillance facilities. Hospital survivors were followed up for 5 years. Results: Overall, 220 patients were included, of which 107 received ICU treatment. The majority of abdominal (77%, P = 0.003) and genitourinary (81%, P < 0.001) infections were found in ICU and non‐ICU patients, respectively. Time to first antibiotic administration was longer in ICU‐patients (median 3.5 vs. 2.0 h in non‐ICU patients, P = 0.011). ICU developed more organ dysfunctions than non‐ICU patients ( P < 0.001), nevertheless supportive therapy with vasoactive drugs and non‐invasive ventilation was documented in 22% and 27% of the latter. Median hospital length of stay was 15 vs. 9 days ( P = 0.001), and hospital and 5‐year mortality rates 35% vs. 16% ( P = 0.002) and 57% vs. 58% ( P = 0.892) among ICU and non‐ICU patients, respectively. Increasing age (HR 1.06 (1.04, 1.07) per year, P < 0.001), not care level during hospitalization (HR 1.19 (0.70, 2.02), P = 0.514), influenced long‐term survival. Conclusion: Half of the subjects with community‐acquired severe sepsis never received ICU treatment. Still, use of organ supportive therapy outside the ICU was considerable. Hospital mortality was higher, whereas 5‐year survival was similar when comparing ICU with non‐ICU patients.