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J Infect Chemother. 2014 Mar;20(3):157-62. doi: 10.1016/j.jiac.2013.07.006. Epub 2013 Dec 11.

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

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Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address:
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Kita 2 jou Nishi 5, Kitaku, Sapporo, Hokkaido 060-8638, Japan.
Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
Department of Emergency and Acute Intensive Care Medicine, Fujita Health University, Dengakugakubo 1-98, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Seiryoumachi 2-1, Aobaku, Sendai, Miyagi 980-8575, Japan.
Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan.
Emergency Center, Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Bunkyo 2-2-22, Ichinomiya, Aichi 491-8558, Japan.
Department of Emergency & Critical Care Medicine, Trauma Center St. Mary's Hospital, Tsubukuhonmachi 422, Kurume, Fukuoka 830-8543, Japan.
Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 173-8606, Japan.
Department of Emergency, Critical Care and Disaster Medicine, Hyogo College of Medicine, Mukogawa 1-1, Nishinomiya, Hyogo 663-8501, Japan.
Advanced Critical Care Center, Aichi Medical University Hospital, Yazakokarimata 1-1, Nagakute, Aichi 480-1195, Japan.
Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi 1-1-5, Bunkyou-ku, Tokyo 113-8603, Japan.
Department of Acute Medicine, Kawasaki Medical School, Matsushima 577, Kurashiki, Okayama 701-0114, Japan.
Department of Critical Care Medicine, Iwate Medical University, Uchimaru 19-1, Morioka, Iwate 020-8505, Japan.
Emergency & Critical Care Center, Kawasaki Municipal Hospital, Shinkawadori 12-1, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan.
Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Minamikogushi 1-1-1, Ube, Yamaguchi 755-8505, Japan.
Department of Trauma & Critical Care Medicine, Kyorin University, School of Medicine, Shinkawa 6-20-2, Mitaka, Tokyo 181-8611, Japan.
Department of Emergency & Critical Care Medicine, School of Medicine, Kurume University, Asahimachi 67, Kurume, Fukuoka 830-0011, Japan.


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 patients were registered at 15 general critical care centers in Japanese tertiary care hospitals when 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) II and Sequential Organ Failure Assessment (SOFA) scores were 23.4 and 8.6, respectively. The 28-day mortality was 23.1%, and overall hospital mortality was 29.5%. SOFA score and disseminated intravascular coagulation (DIC) score were consistently higher in nonsurvivors than survivors on Days 1 and 4. SOFA score, DIC score on Days 1 and 4, and hospital mortality were higher in patients with than without septic shock. SOFA score on Days 1 and 4 and hospital mortality were higher in patients with than without DIC. Logistic regression analyses showed age, presence of septic shock, DIC, and cardiovascular dysfunction at enrollment to be predictors of 28-day mortality and presence of comorbidity to be an additional predictor of hospital mortality. Presence of septic shock or DIC resulted in approximately twice the mortality of patients without each factor, whereas the presence of comorbidity may be a significant predictor of delayed mortality in severe sepsis.


DIC; Epidemiology; Japan; Outcome; Septic shock; Severe sepsis

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