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Original Investigation | Caring for the Critically Ill Patient

Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000-2012

Kirsi-Maija Kaukonen, MD, PhD, EDIC1,2; Michael Bailey, PhD1; Satoshi Suzuki, MD3; David Pilcher, FCICM1,4,5; Rinaldo Bellomo, MD, PhD1,3
[+] Author Affiliations
1Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
2Critical Care Research Group, Intensive Care Unit, Helsinki University Central Hospital, Helsinki, Finland
3Intensive Care Unit, Austin Health, Heidelberg, Australia
4ANZICS Centre for Outcome and Resource Evaluation CORE, Melbourne, Australia
5Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
JAMA. 2014;311(13):1308-1316. doi:10.1001/jama.2014.2637.
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Published online

Importance  Severe sepsis and septic shock are major causes of mortality in intensive care unit (ICU) patients. It is unknown whether progress has been made in decreasing their mortality rate.

Objective  To describe changes in mortality for severe sepsis with and without shock in ICU patients.

Design, Setting, and Participants  Retrospective, observational study from 2000 to 2012 including 101 064 patients with severe sepsis from 171 ICUs with various patient case mix in Australia and New Zealand.

Main Outcomes and Measures  Hospital outcome (mortality and discharge to home, to other hospital, or to rehabilitation).

Results  Absolute mortality in severe sepsis decreased from 35.0% (95% CI, 33.2%-36.8%; 949/2708) to 18.4% (95% CI, 17.8%-19.0%; 2300/12 512; P < .001), representing an overall decrease of 16.7% (95% CI, 14.8%-18.6%), an annual rate of absolute decrease of 1.3%, and a relative risk reduction of 47.5% (95% CI, 44.1%-50.8%). After adjusted analysis, mortality decreased throughout the study period with an odds ratio (OR) of 0.49 (95% CI, 0.46-0.52) in 2012, using the year 2000 as the reference (P < .001). The annual decline in mortality did not differ significantly between patients with severe sepsis and those with all other diagnoses (OR, 0.94 [95% CI, 0.94-0.95] vs 0.94 [95% CI, 0.94-0.94]; P = .37). The annual increase in rates of discharge to home was significantly greater in patients with severe sepsis compared with all other diagnoses (OR, 1.03 [95% CI, 1.02-1.03] vs 1.01 [95% CI, 1.01-1.01]; P < .001). Conversely, the annual increase in the rate of patients discharged to rehabilitation facilities was significantly less in severe sepsis compared with all other diagnoses (OR, 1.08 [95% CI, 1.07-1.09] vs 1.09 [95% CI, 1.09-1.10]; P < .001). In the absence of comorbidities and older age, mortality was less than 5%.

Conclusions and Relevance  In critically ill patients in Australia and New Zealand with severe sepsis with and without shock, there was a decrease in mortality from 2000 to 2012. These findings were accompanied by changes in the patterns of discharge to home, rehabilitation, and other hospitals.

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Figure 1.
Mean Annual Mortality in Patients With Severe Sepsis

Error bars indicate 95% CI.

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Figure 2.
Adjusted Annual Odds for the Change in Hospital Outcomes Reported as Odds Ratios Referenced Against the Year 2000

When considered as a continuous variable, there was no difference between patients with severe sepsis or septic shock and other patients in the database for the decline in mortality over time (odds ratio [OR], 0.94 [95% CI, 0.94-0.95] vs 0.94 [95% CI, 0.94-0.94]; P = .37), whereas significant differences were observed in the change over time for discharge to home (OR, 1.03 [95% CI, 1.02-1.03] vs 1.01 [95% CI, 1.01-1.01]; P < .001) and discharge to rehabilitation facilities (OR, 1.08 [95% CI, 1.07-1.09] vs 1.09 [95% CI, 1.09-1.10]; P < .001). Discharge to rehabilitation included discharge to rehabilitation facilities and chronic care facilities such as nursing homes. ICU indicates intensive care unit.

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