COMMENTARY

Severe Sepsis and Mortality: 20 Years of Trends

Greg Martin, MD

Disclosures

October 17, 2014

Two Decades of Mortality Trends Among Patients With Severe Sepsis: A Comparative Meta-Analysis

Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ
Crit Care Med. 2014;42:625-631

Summary

Severe sepsis is a relatively common and potentially lethal condition among intensive care unit (ICU) patients[1] and has been demonstrated to be increasing in incidence in the United States.[2] The authors sought to determine whether temporal trends in severe sepsis mortality using clinical trial data match the findings from epidemiology studies relying upon administrative data by performing a meta-analysis of clinical trials.

They identified 3244 potentially eligible articles and included 36 multicenter severe sepsis trials with a total of 14,418 participants in the control arm. The 28-day mortality averaged 33.2%, and observed mortality decreased 3% annually (P = .009), decreasing from 46.9% during years 1991-1995 to 29% during years 2006-2009. Trends in hospital mortality among patients with severe sepsis identified from administrative data (Angus definition, 4.7% annual change; 95% confidence interval [CI], 4.1%-5.3%; P = .69 and Martin definition, 3.5% annual change; 95% CI, 3.0%-4.1%; P = .97) were similar to trends identified from clinical trials.

The authors concluded that since 1991, patients with severe sepsis have experienced decreasing mortality according to both clinical trials and administrative data.

Viewpoint

Sepsis is a common and lethal condition, making it important to understand both the pathophysiology and the epidemiology. The greatest advances in studying the epidemiology of sepsis have come from using large-scale datasets, particularly where longitudinal data are available.[2]

However, there are differences reported between datasets and inclusion strategies,[3] and it has not been known how well they matched with patient data. This study demonstrates that sepsis mortality has indeed been falling over the past 20 years, as was suggested in a prior evaluation of clinical trial results.[4]

This study also demonstrates that administrative data may be used to track these changes with reasonable accuracy. However, the implementation of the International Classification of Diseases, 10th revision (ICD-10) may require re-evaluation of this validity.[5]

Abstract

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