Epidemiology of severe sepsis in Japanese intensive care units: A prospective multicenter study

Severe sepsis is a leading cause of morbidity and mortality in the intensive care unit (ICU).We conducted a prospective multicenter study to evaluate epidemiology and outcome of severe sepsis in Japanese ICUs. The patientswere registered at 15 general critical care centers in Japanese tertiary care hospitalswhen diagnosed as having severe sepsis. Of 14,417 patients, 624 (4.3%) were diagnosed with severe sepsis. Demographic and clinical characteristics at enrollment (Day 1), physiologic and blood variables on Days 1 and 4, and mortality were evaluated. Mean age was 69.0 years, and initial mean Acute Physiology and Chronic Health Evaluation (APACHE) IIandSequentialOrganFailureAssessment (SOFA) scoreswere23.4and8.6, respectively.The28-day mortality was 23.1%, and overall hospital mortality was 29.5%. SOFA score and disseminated intravascular coagulation (DIC) scorewere consistently higher in nonsurvivors than survivors on Days 1 and 4. SOFA score, DIC score onDays 1 and 4, and hospitalmortalitywere higher inpatientswith thanwithout septic shock. SOFA score onDays 1 and4 andhospitalmortalitywere higher inpatients with thanwithoutDIC. Logistic regression analyses showed age, presence of septic shock, DIC, and cardiovascular dysfunction at enrollment to be predictors of 28-daymortality and presence of comorbidity to be an additional predictor of hospitalmortality. Presence of septic shock or DIC resulted in approximately twice themortality of patients without each factor, whereas the presence of comorbiditymay be a significant predictor of delayed mortality in severe sepsis.