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Crit Care. 2018 Nov 22;22(1):322. doi: 10.1186/s13054-018-2186-7.

Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study.

Author information

1
Department of General Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. abetoshi111@gmail.com.
2
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan. abetoshi111@gmail.com.
3
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
4
Emergency and Trauma Center, Kameda Medical Center, Kamogawa, Japan.
5
Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
6
Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan.
7
Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan.
8
Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
9
Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan.
10
Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine, Chiba, Japan.
11
Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan.
12
Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan.
13
Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
14
Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan.
15
Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
16
Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan.
17
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
18
Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan.
19
Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan.
20
Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube, Japan.
21
Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
22
Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan.
23
Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
24
Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan.
25
Advanced Emergency Medical Service Center Kurume University Hospital, Kurume, Japan.
26
Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan.
27
Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan.
28
Division of Acute and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

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.

KEYWORDS:

Bundle; Elderly; Resuscitation; Sepsis

PMID:
30466493
PMCID:
PMC6251147
DOI:
10.1186/s13054-018-2186-7
[Indexed for MEDLINE]
Free PMC Article

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