Epidemiology Of Sepsis In ICUs Of Western Regions Of China

Background and objectiveSepsis is one of the most common severe diseases in intensive care unit(ICU),which can cause multiple organ failure and death,and also is the leading cause of the third death peak for trauma patients.The sepsis treatment guideline which was proposed in the Barcelona Declaration in 2002 is updated with the development of the latest pathophysiological research progress.The sepsis treatment guideline has saved the lives of hundreds of millions of patients with sepsis,and has reduced the morbidity and mortality of sepsis to a certain extent.But in general,sepsis is still the first cause of death in severe patients such as severe trauma patients.In the United States,more than 750,000 people occur sepsis each year,with the mortality as high as 30% to 50%.But in China,there is no report about the epidemiology of sepsis in ICU patients in China’s western regions and ICU medial staff’s medical knowledge about the sepsis treatment guideline.This study aims to provide more epidemiological information about sepsis in ICUs of China’s western regions.This study aims to obtain the first-hand information such as sepsis incidence,risk factors,infection in western regions of China,to investigate the relationship between medical staff’s cognition about sepsis guidelines and sepsis prevalence and death rate,to discuss the relationship between the prevalence of sepsis and the diseases type of ICU,and to define the diagnostic sensitivity,specificity and effectiveness of the three international sepsis guidelines which was proposed in 1992,2001 and 2012,respectively.MethodsFrom Jun.2014 to Aug.2014,a one-day cross-sectional survey was conducted in 5 ICUs in the cities of Chongqing and Guizhou,China.Also,the 28-day mortality of the enrolled patients was followed up.Inclusion criteria included age over 18 years and more than 24 hours of ICU admission.This survey covered information such as the enrolled hospital information,basic and clinical features of the enrolled patients,infection-related data,diagnosis of sepsis and risk factors.Questionnaires and interviews were conducted to investigate the knowledge of medical staff about the 2012 sepsis guideline,and statistical analysis was conducted for studying its relationship with sepsis morbidity and mortality,so as to find out the relationship between the sepsis cognition and the prevalence and mortality of sepsis.The included patients were divided into internal medicine group,surgery group and trauma group in accordance with their disease type.Their sepsis was diagnosed according to the 2012 international sepsis guideline,and the sepsis prevalence and 28-day mortality in each group were statistically analyzed.Also,the included ICU patients were divided into 1992 criteria group,2001 criteria group and 2012 criteria group in accordance with the diagnostic criteria for 1992,2001 and 2012 international sepsis guidelines,the positive pathogen culture was used as the "gold standard" for diagnosing sepsis,the sensitivity and specificity of the three 3 versions of sepsis guidelines were calculated and statistically analyzed,and the diagnostic efficacy of the three versions of guidelines was evaluated.ResultsA total of 85 patients were enrolled,71 of whom met the inclusion criteria,and 14 of whom were excluded.The mean age was(59.5 ± 17.0)years,49 patients were males(69%),the Acute Physiology and Chronic Health Evaluation II(APACHE II)score was(21.1 ± 8.1)points,the Sequential Organ Failure Assessment(SOFA)score was(7.5 ± 4.1)points,the average of Glasgow coma Scale(GCS)was(7.5 ± 4.1)points,and the average ICU stay was 8(2-20.5)days.There were 56 patients with sepsis,with the prevalence rate of 78.9%;there were 46 patients with severe sepsis,with the prevalence of 64.8%.Eighteen sepsis patients died within 28 days,with the 28-day mortality of 25.3%.The number of patients in the enrolled 5 ICUs were 30,10,11,7,13,respetively;and the number of the sepsis patients in the enrolled 5 ICUs were 20,9,10,7,10,respectively,with the sepsis prevalence of 66.7%,90.0%,90.9%,100% and 76.9%,respectively;the number of severe sepsis patients of the 5 enrolled hospitals was 19,6,9,5,7,respectively,with the prevalence rate of 63.3%,60.0%,81.8%,71.4%,53.8 %,respectively.A total of 31 doctors were involved in sepsis guide questionnaire,and the number of participated doctors in the 5 ICUs was 8,7,5,4,7,respectively.The average cognitive score in the 5 ICUs was(68.5 ± 15.4)points,(65.7 ± 16.7)points,(69.0 ± 23.3)points,(25.0 ± 8.4)points,(61.4 ± 19.9)points,respectively.The cognitive score was not associated with the prevalence of sepsis and severe sepsis,was negatively related with the 28-day mortality.The number of patients in the internal medicine group,surgery group and trauma group was 27,21,23,respectively,and the number of sepsis patients in groups A,B,C was 22,14,20,respectively,with the prevalence rate of 81.5%,66.7%,87.0%,respectively.The number of severe sepsis patients in groups A,B,C was 18,12,16,respectively,with the prevalence rate of 66.7%,57.1%,70.0%,respectively.The number of patients who died within 28 days in groups A,B,C was 8,7,3,respectively,with the 28-day mortality of 36.4%,42.9% and 20%.There was no statistical difference in the number of sepsis patients,the number of severe sepsis patients,and the number of 28-day death patients.Thirty ICU patients were enrolled,of whom,23 in the 1992 criteria group met the diagnostic criteria for sepsis,22 in the 2001 criteria group met the diagnostic criteria for sepsis,and 20 in the 2012 criteria group met the diagnostic criteria for sepsis,with the prevalence rate of 76.7%,73.3%,66.7%,respectively.There was no significantly statistical difference between three diagnostic criteria.Four patients died within 28 days,and also met the diagnostic criteria of the three versions of guidelines.The 28-day mortality of the three groups was 17.4%,18.2%,25%,without significantly statistical difference.In the 1992 criteria group,the diagnostic sensitivity was 77.8% and the specificity was 25%;in the 2001 criteria group,the diagnostic sensitivity was 88.9% and the specificity was 16.7%;in the 2012 criteria group,the diagnostic sensitivity was 72.2%,and the specificity was 41.6%.No significant difference was observed in sensitivity and specificity among the three versions of guidelines.ConclusionThe prevalence of sepsis and severe sepsis in the western regions of China is high,medical staff’s cognition about sepsis guideline is related with prognosis of sepsis patients,and the prevalence of sepsis and mortality is not associated with the admission disease types.There is no difference in the diagnostic effectiveness among the three versions of guidelines.The 1992 international sepsis guideline is relatively simple and may be more beneficial for the diagnosis of sepsis.