Variations in infection sites and mortality rates among patients in intensive care units with severe sepsis and septic shock in Japan

Toshikazu Abe, Hiroshi Ogura, Shigeki Kushimoto, Atsushi Shiraishi, Takehiro Sugiyama, Gautam A. Deshpande, Masatoshi Uchida, Isao Nagata, Daizoh Saitoh, Seitaro Fujishima, Toshihiko Mayumi, Toru Hifumi, Yasukazu Shiino, Taka Aki Nakada, Takehiko Tarui, Yasuhiro Otomo, Kohji Okamoto, Yutaka Umemura, Joji Kotani, Yuichiro Sakamoto & 13 others Junichi Sasaki, Shin Ichiro Shiraishi, Kiyotsugu Takuma, Ryosuke Tsuruta, Akiyoshi Hagiwara, Kazuma Yamakawa, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Satoshi Fujimi, Satoshi Gando

Research output: Contribution to journalArticle

Abstract

Background: Accurate and early identification of infection sites might help to drive crucial decisions regarding the treatment of sepsis. We aimed to determine the clinical and etiological features of infection according to sites among patients with severe sepsis in Japan. Methods: This secondary analysis of a multicenter, prospective cohort study included 59 intensive care units (ICU) and proceeded between January 2016 and March 2017. The study cohort comprised 1184 adults (≥ 16 years) who were admitted to an ICU with severe sepsis and septic shock diagnosed according to the sepsis-2 criteria. Sites of infection diagnosed by physicians in charge at the time of arrival comprised the lung, abdomen, urinary tract, soft tissue, bloodstream, central nervous system (CNS), and undifferentiated infections. The primary outcome was in-hospital mortality. Results: The most common sites of infection were the lungs (31.0%), followed by intra-abdominal sites (26.3%), the urinary tract (18.4%), and soft tissue (10.9%). The characteristics of the patients with severe sepsis across seven major suspected infection sites were heterogeneous. Septic shock was more frequent among patients with intra-abdominal (72.2%) and urinary tract (70.2%) infections than other sites. The in-hospital mortality rate due to severe sepsis and septic shock of a pooled sample was 23.4% (range, 11.9% [urinary tract infection] to 47.6% [CNS infection]). After adjusting for clinical background, sepsis severity, and stratification according to the presence or absence of shock, variations in hospital mortality across seven major sites of infection remained essentially unchanged from those for crude in-hospital mortality; adjusted in-hospital mortality rates ranged from 7.7% (95%CI, - 0.3 to 15.8) for urinary tract infection without shock to 58.3% (95%CI, 21.0-95.7) for CNS infection with shock in a generalized estimating equation model. Intra-abdominal and urinary tract infections were statistically associated with less in-hospital mortality than pneumonia. Infections of the CNS were statistically associated with higher in-hospital mortality rates than pneumonia in a logistic regression model, but not in the generalized estimating equation model. Conclusions: In-hospital mortality and clinical features of patients with severe sepsis and septic shock were heterogeneous according to sites of infection.

Original languageEnglish
Article number28
JournalJournal of Intensive Care
Volume7
Issue number1
DOIs
Publication statusPublished - 2019 May 3

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Septic Shock
Hospital Mortality
Intensive Care Units
Sepsis
Japan
Central Nervous System Infections
Mortality
Infection
Urinary Tract Infections
Shock
Urinary Tract
Pneumonia
Cohort Studies
Logistic Models
Lung
Abdomen
Prospective Studies
Physicians

Keywords

  • Heterogeneity
  • Infection
  • Sepsis
  • Survival
  • Therapy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Variations in infection sites and mortality rates among patients in intensive care units with severe sepsis and septic shock in Japan. / Abe, Toshikazu; Ogura, Hiroshi; Kushimoto, Shigeki; Shiraishi, Atsushi; Sugiyama, Takehiro; Deshpande, Gautam A.; Uchida, Masatoshi; Nagata, Isao; Saitoh, Daizoh; Fujishima, Seitaro; Mayumi, Toshihiko; Hifumi, Toru; Shiino, Yasukazu; Nakada, Taka Aki; Tarui, Takehiko; 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.

In: Journal of Intensive Care, Vol. 7, No. 1, 28, 03.05.2019.

Research output: Contribution to journalArticle

Abe, T, Ogura, H, Kushimoto, S, Shiraishi, A, Sugiyama, T, Deshpande, GA, Uchida, M, Nagata, I, Saitoh, D, Fujishima, S, Mayumi, T, Hifumi, T, Shiino, Y, Nakada, TA, Tarui, 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 2019, 'Variations in infection sites and mortality rates among patients in intensive care units with severe sepsis and septic shock in Japan', Journal of Intensive Care, vol. 7, no. 1, 28. https://doi.org/10.1186/s40560-019-0383-3
Abe, Toshikazu ; Ogura, Hiroshi ; Kushimoto, Shigeki ; Shiraishi, Atsushi ; Sugiyama, Takehiro ; Deshpande, Gautam A. ; Uchida, Masatoshi ; Nagata, Isao ; Saitoh, Daizoh ; Fujishima, Seitaro ; Mayumi, Toshihiko ; Hifumi, Toru ; Shiino, Yasukazu ; Nakada, Taka Aki ; Tarui, Takehiko ; 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. / Variations in infection sites and mortality rates among patients in intensive care units with severe sepsis and septic shock in Japan. In: Journal of Intensive Care. 2019 ; Vol. 7, No. 1.
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abstract = "Background: Accurate and early identification of infection sites might help to drive crucial decisions regarding the treatment of sepsis. We aimed to determine the clinical and etiological features of infection according to sites among patients with severe sepsis in Japan. Methods: This secondary analysis of a multicenter, prospective cohort study included 59 intensive care units (ICU) and proceeded between January 2016 and March 2017. The study cohort comprised 1184 adults (≥ 16 years) who were admitted to an ICU with severe sepsis and septic shock diagnosed according to the sepsis-2 criteria. Sites of infection diagnosed by physicians in charge at the time of arrival comprised the lung, abdomen, urinary tract, soft tissue, bloodstream, central nervous system (CNS), and undifferentiated infections. The primary outcome was in-hospital mortality. Results: The most common sites of infection were the lungs (31.0{\%}), followed by intra-abdominal sites (26.3{\%}), the urinary tract (18.4{\%}), and soft tissue (10.9{\%}). The characteristics of the patients with severe sepsis across seven major suspected infection sites were heterogeneous. Septic shock was more frequent among patients with intra-abdominal (72.2{\%}) and urinary tract (70.2{\%}) infections than other sites. The in-hospital mortality rate due to severe sepsis and septic shock of a pooled sample was 23.4{\%} (range, 11.9{\%} [urinary tract infection] to 47.6{\%} [CNS infection]). After adjusting for clinical background, sepsis severity, and stratification according to the presence or absence of shock, variations in hospital mortality across seven major sites of infection remained essentially unchanged from those for crude in-hospital mortality; adjusted in-hospital mortality rates ranged from 7.7{\%} (95{\%}CI, - 0.3 to 15.8) for urinary tract infection without shock to 58.3{\%} (95{\%}CI, 21.0-95.7) for CNS infection with shock in a generalized estimating equation model. Intra-abdominal and urinary tract infections were statistically associated with less in-hospital mortality than pneumonia. Infections of the CNS were statistically associated with higher in-hospital mortality rates than pneumonia in a logistic regression model, but not in the generalized estimating equation model. Conclusions: In-hospital mortality and clinical features of patients with severe sepsis and septic shock were heterogeneous according to sites of infection.",
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TY - JOUR

T1 - Variations in infection sites and mortality rates among patients in intensive care units with severe sepsis and septic shock in Japan

AU - Abe, Toshikazu

AU - Ogura, Hiroshi

AU - Kushimoto, Shigeki

AU - Shiraishi, Atsushi

AU - Sugiyama, Takehiro

AU - Deshpande, Gautam A.

AU - Uchida, Masatoshi

AU - Nagata, Isao

AU - Saitoh, Daizoh

AU - Fujishima, Seitaro

AU - Mayumi, Toshihiko

AU - Hifumi, Toru

AU - Shiino, Yasukazu

AU - Nakada, Taka Aki

AU - Tarui, Takehiko

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

PY - 2019/5/3

Y1 - 2019/5/3

N2 - Background: Accurate and early identification of infection sites might help to drive crucial decisions regarding the treatment of sepsis. We aimed to determine the clinical and etiological features of infection according to sites among patients with severe sepsis in Japan. Methods: This secondary analysis of a multicenter, prospective cohort study included 59 intensive care units (ICU) and proceeded between January 2016 and March 2017. The study cohort comprised 1184 adults (≥ 16 years) who were admitted to an ICU with severe sepsis and septic shock diagnosed according to the sepsis-2 criteria. Sites of infection diagnosed by physicians in charge at the time of arrival comprised the lung, abdomen, urinary tract, soft tissue, bloodstream, central nervous system (CNS), and undifferentiated infections. The primary outcome was in-hospital mortality. Results: The most common sites of infection were the lungs (31.0%), followed by intra-abdominal sites (26.3%), the urinary tract (18.4%), and soft tissue (10.9%). The characteristics of the patients with severe sepsis across seven major suspected infection sites were heterogeneous. Septic shock was more frequent among patients with intra-abdominal (72.2%) and urinary tract (70.2%) infections than other sites. The in-hospital mortality rate due to severe sepsis and septic shock of a pooled sample was 23.4% (range, 11.9% [urinary tract infection] to 47.6% [CNS infection]). After adjusting for clinical background, sepsis severity, and stratification according to the presence or absence of shock, variations in hospital mortality across seven major sites of infection remained essentially unchanged from those for crude in-hospital mortality; adjusted in-hospital mortality rates ranged from 7.7% (95%CI, - 0.3 to 15.8) for urinary tract infection without shock to 58.3% (95%CI, 21.0-95.7) for CNS infection with shock in a generalized estimating equation model. Intra-abdominal and urinary tract infections were statistically associated with less in-hospital mortality than pneumonia. Infections of the CNS were statistically associated with higher in-hospital mortality rates than pneumonia in a logistic regression model, but not in the generalized estimating equation model. Conclusions: In-hospital mortality and clinical features of patients with severe sepsis and septic shock were heterogeneous according to sites of infection.

AB - Background: Accurate and early identification of infection sites might help to drive crucial decisions regarding the treatment of sepsis. We aimed to determine the clinical and etiological features of infection according to sites among patients with severe sepsis in Japan. Methods: This secondary analysis of a multicenter, prospective cohort study included 59 intensive care units (ICU) and proceeded between January 2016 and March 2017. The study cohort comprised 1184 adults (≥ 16 years) who were admitted to an ICU with severe sepsis and septic shock diagnosed according to the sepsis-2 criteria. Sites of infection diagnosed by physicians in charge at the time of arrival comprised the lung, abdomen, urinary tract, soft tissue, bloodstream, central nervous system (CNS), and undifferentiated infections. The primary outcome was in-hospital mortality. Results: The most common sites of infection were the lungs (31.0%), followed by intra-abdominal sites (26.3%), the urinary tract (18.4%), and soft tissue (10.9%). The characteristics of the patients with severe sepsis across seven major suspected infection sites were heterogeneous. Septic shock was more frequent among patients with intra-abdominal (72.2%) and urinary tract (70.2%) infections than other sites. The in-hospital mortality rate due to severe sepsis and septic shock of a pooled sample was 23.4% (range, 11.9% [urinary tract infection] to 47.6% [CNS infection]). After adjusting for clinical background, sepsis severity, and stratification according to the presence or absence of shock, variations in hospital mortality across seven major sites of infection remained essentially unchanged from those for crude in-hospital mortality; adjusted in-hospital mortality rates ranged from 7.7% (95%CI, - 0.3 to 15.8) for urinary tract infection without shock to 58.3% (95%CI, 21.0-95.7) for CNS infection with shock in a generalized estimating equation model. Intra-abdominal and urinary tract infections were statistically associated with less in-hospital mortality than pneumonia. Infections of the CNS were statistically associated with higher in-hospital mortality rates than pneumonia in a logistic regression model, but not in the generalized estimating equation model. Conclusions: In-hospital mortality and clinical features of patients with severe sepsis and septic shock were heterogeneous according to sites of infection.

KW - Heterogeneity

KW - Infection

KW - Sepsis

KW - Survival

KW - Therapy

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U2 - 10.1186/s40560-019-0383-3

DO - 10.1186/s40560-019-0383-3

M3 - Article

VL - 7

JO - Journal of Intensive Care

JF - Journal of Intensive Care

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