Intensive care unit model and in-hospital mortality among patients with severe sepsis and septic shock: A secondary analysis of a multicenter prospective observational study. Issue 21 (28th May 2021)

• Record Type: Journal Article
• Authors: Nagata, Isao; Abe, Toshikazu; Ogura, Hiroshi; Kushimoto, Shigeki; Fujishima, Seitaro; Gando, Satoshi
• Other Names: Eroglu. Ahmet section editor.
• Is Part Of: Medicine. Volume 100:Issue 21(2021)
• Publication Date: 2021-05-28
• Subjects: ICU model -- in-hospital mortality -- sepsis -- sepsis care bundle; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000026132
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Abstract: We aimed to determine the association between the intensive care unit (ICU) model and in-hospital mortality of patients with severe sepsis and septic shock. This was a secondary analysis of a multicenter prospective observational study conducted in 59 ICUs in Japan from January 2016 to March 2017. We included adult patients (aged ≥16 years) with severe sepsis and septic shock based on the sepsis-2 criteria who were admitted to an ICU with a 1:2 nurse-to-patient ratio per shift. Patients were categorized into open or closed ICU groups, according to the ICU model. The primary outcome was in-hospital mortality. A total of 1018 patients from 45 ICUs were included in this study. Patients in the closed ICU group had a higher severity score and higher organ failure incidence than those in the open ICU group. The compliance rate for the sepsis care 3-h bundle was higher in the closed ICU group than in the open ICU group. In-hospital mortality was not significantly different between the closed and open ICU groups in a multilevel logistic regression analysis (odds ratio = 0.83, 95% confidence interval; 0.52–1.32, P = .43) and propensity score matching analysis (closed ICU, 21.2%; open ICU, 25.7%, P = .22). In-hospital mortality between the closed and open ICU groups was not significantly different after adjusting for ICU structure and compliance with the sepsis care bundle. Abstract : Supplemental Digital Content is available in the text