Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan

The FORECAST study

Toshikazu Abe, Hiroshi Ogura, Atsushi Shiraishi, Shigeki Kushimoto, Daizoh Saitoh, Seitaro Fujishima, Toshihiko Mayumi, Yasukazu Shiino, Taka Aki Nakada, Takehiko Tarui, Toru Hifumi, Yasuhiro Otomo, Kohji Okamoto, Yutaka Umemura, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin Ichiro Shiraishi, Kiyotsugu Takuma, Ryosuke Tsuruta & 43 others Akiyoshi Hagiwara, Kazuma Yamakawa, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Satoshi Fujimi, Satoshi Gando, Osamu Tasaki, Yasumitsu Mizobata, Hiraku Funakoshi, Toshiro Okuyama, Iwao Yamashita, Toshio Kanai, Yasuo Yamada, Mayuki Aibiki, Keiji Sato, Susumu Yamashita, Kenichi Yoshida, Shunji Kasaoka, Akihide Kon, Hiroshi Rinka, Hiroshi Kato, Hiroshi Okudera, Eichi Narimatsu, Toshifumi Fujiwara, Manabu Sugita, Yasuo Shichinohe, Hajime Nakae, Ryouji Iiduka, Mitsunobu Nakamura, Yuji Murata, Yoshitake Sato, Hiroyasu Ishikura, Yasuhiro Myojo, Yasuyuki Tsujita, Kosaku Kinoshita, Hiroyuki Yamaguchi, Toshihiro Sakurai, Satoru Miyatake, Takao Saotome, Susumu Yasuda

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan. Methods: This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria. Results: In total, 1184 patients (median age 73 years, interquartile range (IQR) 64-81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6-11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21-26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12-46) days. Approximately 37% of the patients were discharged home after recovery. Conclusion: Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan. Trial registration: UMIN-CTR, UMIN000019742. Registered on 16 November 2015.

Original languageEnglish
Article number322
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - 2018 Nov 22

Fingerprint

Adult Respiratory Distress Syndrome
Emergency Medical Services
Hospital Mortality
Intensive Care Units
Sepsis
Japan
Outcome Assessment (Health Care)
Wounds and Injuries
Organ Dysfunction Scores
Comorbidity
Developed Countries
Length of Stay
Cohort Studies
Logistic Models
Prospective Studies
Central Venous Pressure
Central Venous Catheters
Mortality
Septic Shock
Infection

Keywords

  • Bundle
  • Elderly
  • Resuscitation
  • Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan : The FORECAST study. / Abe, Toshikazu; Ogura, Hiroshi; Shiraishi, Atsushi; Kushimoto, Shigeki; Saitoh, Daizoh; Fujishima, Seitaro; Mayumi, Toshihiko; Shiino, Yasukazu; Nakada, Taka Aki; Tarui, Takehiko; Hifumi, Toru; Otomo, Yasuhiro; Okamoto, Kohji; Umemura, Yutaka; Kotani, Joji; Sakamoto, Yuichiro; Sasaki, Junichi; Shiraishi, Shin Ichiro; Takuma, Kiyotsugu; Tsuruta, Ryosuke; Hagiwara, Akiyoshi; Yamakawa, Kazuma; Masuno, Tomohiko; Takeyama, Naoshi; Yamashita, Norio; Ikeda, Hiroto; Ueyama, Masashi; Fujimi, Satoshi; Gando, Satoshi; Tasaki, Osamu; Mizobata, Yasumitsu; Funakoshi, Hiraku; Okuyama, Toshiro; Yamashita, Iwao; Kanai, Toshio; Yamada, Yasuo; Aibiki, Mayuki; Sato, Keiji; Yamashita, Susumu; Yoshida, Kenichi; Kasaoka, Shunji; Kon, Akihide; Rinka, Hiroshi; Kato, Hiroshi; Okudera, Hiroshi; Narimatsu, Eichi; Fujiwara, Toshifumi; Sugita, Manabu; Shichinohe, Yasuo; Nakae, Hajime; Iiduka, Ryouji; Nakamura, Mitsunobu; Murata, Yuji; Sato, Yoshitake; Ishikura, Hiroyasu; Myojo, Yasuhiro; Tsujita, Yasuyuki; Kinoshita, Kosaku; Yamaguchi, Hiroyuki; Sakurai, Toshihiro; Miyatake, Satoru; Saotome, Takao; Yasuda, Susumu.

In: Critical Care, Vol. 22, No. 1, 322, 22.11.2018.

Research output: Contribution to journalArticle

Abe, T, Ogura, H, Shiraishi, A, Kushimoto, S, Saitoh, D, Fujishima, S, Mayumi, T, Shiino, Y, Nakada, TA, Tarui, T, Hifumi, T, Otomo, Y, Okamoto, K, Umemura, Y, Kotani, J, Sakamoto, Y, Sasaki, J, Shiraishi, SI, Takuma, K, Tsuruta, R, Hagiwara, A, Yamakawa, K, Masuno, T, Takeyama, N, Yamashita, N, Ikeda, H, Ueyama, M, Fujimi, S, Gando, S, Tasaki, O, Mizobata, Y, Funakoshi, H, Okuyama, T, Yamashita, I, Kanai, T, Yamada, Y, Aibiki, M, Sato, K, Yamashita, S, Yoshida, K, Kasaoka, S, Kon, A, Rinka, H, Kato, H, Okudera, H, Narimatsu, E, Fujiwara, T, Sugita, M, Shichinohe, Y, Nakae, H, Iiduka, R, Nakamura, M, Murata, Y, Sato, Y, Ishikura, H, Myojo, Y, Tsujita, Y, Kinoshita, K, Yamaguchi, H, Sakurai, T, Miyatake, S, Saotome, T & Yasuda, S 2018, 'Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: The FORECAST study', Critical Care, vol. 22, no. 1, 322. https://doi.org/10.1186/s13054-018-2186-7
Abe, Toshikazu ; Ogura, Hiroshi ; Shiraishi, Atsushi ; Kushimoto, Shigeki ; Saitoh, Daizoh ; Fujishima, Seitaro ; Mayumi, Toshihiko ; Shiino, Yasukazu ; Nakada, Taka Aki ; Tarui, Takehiko ; Hifumi, Toru ; Otomo, Yasuhiro ; Okamoto, Kohji ; Umemura, Yutaka ; Kotani, Joji ; Sakamoto, Yuichiro ; Sasaki, Junichi ; Shiraishi, Shin Ichiro ; Takuma, Kiyotsugu ; Tsuruta, Ryosuke ; Hagiwara, Akiyoshi ; Yamakawa, Kazuma ; Masuno, Tomohiko ; Takeyama, Naoshi ; Yamashita, Norio ; Ikeda, Hiroto ; Ueyama, Masashi ; Fujimi, Satoshi ; Gando, Satoshi ; Tasaki, Osamu ; Mizobata, Yasumitsu ; Funakoshi, Hiraku ; Okuyama, Toshiro ; Yamashita, Iwao ; Kanai, Toshio ; Yamada, Yasuo ; Aibiki, Mayuki ; Sato, Keiji ; Yamashita, Susumu ; Yoshida, Kenichi ; Kasaoka, Shunji ; Kon, Akihide ; Rinka, Hiroshi ; Kato, Hiroshi ; Okudera, Hiroshi ; Narimatsu, Eichi ; Fujiwara, Toshifumi ; Sugita, Manabu ; Shichinohe, Yasuo ; Nakae, Hajime ; Iiduka, Ryouji ; Nakamura, Mitsunobu ; Murata, Yuji ; Sato, Yoshitake ; Ishikura, Hiroyasu ; Myojo, Yasuhiro ; Tsujita, Yasuyuki ; Kinoshita, Kosaku ; Yamaguchi, Hiroyuki ; Sakurai, Toshihiro ; Miyatake, Satoru ; Saotome, Takao ; Yasuda, Susumu. / Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan : The FORECAST study. In: Critical Care. 2018 ; Vol. 22, No. 1.
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abstract = "Background: Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan. Methods: This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria. Results: In total, 1184 patients (median age 73 years, interquartile range (IQR) 64-81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23{\%}). Moreover, approximately 63{\%} of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6-11). The most common site of infection was the lung (31{\%}). Approximately 54{\%} of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64{\%}, 26{\%}, and 7{\%}, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23{\%} (21-26{\%}). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12-46) days. Approximately 37{\%} of the patients were discharged home after recovery. Conclusion: Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan. Trial registration: UMIN-CTR, UMIN000019742. Registered on 16 November 2015.",
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TY - JOUR

T1 - Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan

T2 - The FORECAST study

AU - Abe, Toshikazu

AU - Ogura, Hiroshi

AU - Shiraishi, Atsushi

AU - Kushimoto, Shigeki

AU - Saitoh, Daizoh

AU - Fujishima, Seitaro

AU - Mayumi, Toshihiko

AU - Shiino, Yasukazu

AU - Nakada, Taka Aki

AU - Tarui, Takehiko

AU - Hifumi, Toru

AU - Otomo, Yasuhiro

AU - Okamoto, Kohji

AU - Umemura, Yutaka

AU - Kotani, Joji

AU - Sakamoto, Yuichiro

AU - Sasaki, Junichi

AU - Shiraishi, Shin Ichiro

AU - Takuma, Kiyotsugu

AU - Tsuruta, Ryosuke

AU - Hagiwara, Akiyoshi

AU - Yamakawa, Kazuma

AU - Masuno, Tomohiko

AU - Takeyama, Naoshi

AU - Yamashita, Norio

AU - Ikeda, Hiroto

AU - Ueyama, Masashi

AU - Fujimi, Satoshi

AU - Gando, Satoshi

AU - Tasaki, Osamu

AU - Mizobata, Yasumitsu

AU - Funakoshi, Hiraku

AU - Okuyama, Toshiro

AU - Yamashita, Iwao

AU - Kanai, Toshio

AU - Yamada, Yasuo

AU - Aibiki, Mayuki

AU - Sato, Keiji

AU - Yamashita, Susumu

AU - Yoshida, Kenichi

AU - Kasaoka, Shunji

AU - Kon, Akihide

AU - Rinka, Hiroshi

AU - Kato, Hiroshi

AU - Okudera, Hiroshi

AU - Narimatsu, Eichi

AU - Fujiwara, Toshifumi

AU - Sugita, Manabu

AU - Shichinohe, Yasuo

AU - Nakae, Hajime

AU - Iiduka, Ryouji

AU - Nakamura, Mitsunobu

AU - Murata, Yuji

AU - Sato, Yoshitake

AU - Ishikura, Hiroyasu

AU - Myojo, Yasuhiro

AU - Tsujita, Yasuyuki

AU - Kinoshita, Kosaku

AU - Yamaguchi, Hiroyuki

AU - Sakurai, Toshihiro

AU - Miyatake, Satoru

AU - Saotome, Takao

AU - Yasuda, Susumu

PY - 2018/11/22

Y1 - 2018/11/22

N2 - Background: Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan. Methods: This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria. Results: In total, 1184 patients (median age 73 years, interquartile range (IQR) 64-81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6-11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21-26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12-46) days. Approximately 37% of the patients were discharged home after recovery. Conclusion: Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan. Trial registration: UMIN-CTR, UMIN000019742. Registered on 16 November 2015.

AB - Background: Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan. Methods: This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria. Results: In total, 1184 patients (median age 73 years, interquartile range (IQR) 64-81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6-11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21-26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12-46) days. Approximately 37% of the patients were discharged home after recovery. Conclusion: Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan. Trial registration: UMIN-CTR, UMIN000019742. Registered on 16 November 2015.

KW - Bundle

KW - Elderly

KW - Resuscitation

KW - Sepsis

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U2 - 10.1186/s13054-018-2186-7

DO - 10.1186/s13054-018-2186-7

M3 - Article

VL - 22

JO - Critical Care

JF - Critical Care

SN - 1364-8535

IS - 1

M1 - 322

ER -