Characteristics, Management, and In-hospital Mortality Among Patients with Severe Sepsis in Intensive Care Units in Japan: the FORECAST Study

Overview

Journal Crit Care

Specialty Critical Care

Date 2018 Nov 24

PMID 30466493

Citations 60

Authors

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

Akiyoshi Hagiwara

Kazuma Yamakawa

Tomohiko Masuno

Naoshi Takeyama

Norio Yamashita

Hiroto Ikeda

Masashi Ueyama

Satoshi Fujimi

Satoshi Gando

Affiliations

Soon will be listed here.

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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