Growing burden of sepsis-related mortality in northeastern Italy: a multiple causes of death analysis

BMC Infectious Diseases - Tập 16 - Trang 1-6 - 2016
Ugo Fedeli1, Pasquale Piccinni2, Elena Schievano1, Mario Saugo1, Giampietro Pellizzer3
1Epidemiological Department, Padova (PD), Italy
2Anesthesiology and Intensive Care, Eretenia Hospital, Vicenza, Italy
3Infectious Disease Unit, San Bortolo Hospital, Vicenza, Italy

Tóm tắt

Few population-based data are available on mortality due to sepsis. The aim of the study was to estimate sepsis-related mortality rates and to assess the associated comorbidities. From multiple causes of death data (MCOD) of the Veneto Region (northeastern Italy), all deaths with sepsis mentioned anywhere in the death certificate were retrieved for the period 2008–2013. Among these deaths the prevalence of common chronic comorbidities was investigated, as well as the distribution of the underlying cause of death (UCOD), the single disease selected from all condition mentioned in the certificate and usually tabulated in mortality statistics. Age-standardized mortality rates were computed for sepsis selected as the UCOD, and for sepsis mentioned anywhere in the certificate. Overall 16,906 sepsis-related deaths were tracked. Sepsis was mentioned in 6.3 % of all regional deaths, increasing from 4.9 in 2008 to 7.7 % in 2013. Sepsis was the UCOD in 0.6 % of total deaths in 2008, and in 1.6 % in 2013. Age-standardized mortality rates increased by 45 % for all sepsis-related deaths, and by 140 % for sepsis as the UCOD. Sepsis was often reported in the presence of chronic comorbidities, especially neoplasms, diabetes, circulatory diseases, and dementia. Respiratory tract and intra-abdominal infections were the most frequently associated sites of infection. MCOD analyses provide an estimate of the burden of sepsis-related mortality. MCOD data suggest an increasing importance attributed to sepsis by certifying physicians, but also a real increase in mortality rates, thus confirming trends reported in some other countries by analyses of hospital discharge records.

Tài liệu tham khảo

Jawad I, Lukšić I, Rafnsson SB. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Glob Health. 2012;2:010404. Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, Mcginley E, et al. Nationwide trends of severe sepsis in the 21st century (2000–2007). Chest. 2011;140:1223–31. Sundararajan V, Macisaac CM, Presneill JJ, Cade JF, Visvanathan K. Epidemiology of sepsis in Victoria. Australia Crit Care Med. 2005;33:71–80. Wilhelms SB, Huss FR, Granath G, Sjöberg F. Assessment of incidence of severe sepsis in Sweden using different ways of abstracting international classification of diseases codes: difficulties with methods and interpretation of results. Crit Care Med. 2010;38:1442–9. Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med. 2014;42:625–31. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007;35:1244–50. Bouza C, López-Cuadrado T, Saz-Parkinson Z, Amate-Blanco JM. Epidemiology and recent trends of severe sepsis in Spain: a nationwide population-based analysis (2006–2011). BMC Infect Dis. 2014;14:3863. Wang HE, Addis DR, Donnelly JP, Shapiro NI, Griffin RL, Safford MM, Baddley JW. Discharge diagnoses versus medical record review in the identification of community-acquired sepsis. Crit Care. 2015;19:42. Rhee C, Murphy MV, Li L, Platt R, Klompas M, Centers for Disease Control and Prevention Epicenters Program. Comparison of trends in sepsis incidence and coding using administrative claims versus objective clinical data. Clin Infect Dis. 2015;60:88–95. Govindan S, Shapiro L, Langa KM, Iwashyna TJ. Death certificates underestimate infections as proximal causes of death in the U.S. PLoS One. 2014;9:e97714. Désesquelles A, Demuru E, Pappagallo M, Frova L, Meslé F, Egidi V. After the epidemiologic transition: a reassessment of mortality from infectious diseases among over-65 s in France and Italy. Int J Public Health. 2015;60:961–7. Melamed A, Sorvillo FJ. The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care. 2009;13:R28. McPherson D, Griffiths C, Williams M, Baker A, Klodawski E, Jacobson B, Donaldson L. Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010. BMJ Open. 2013;3(8). Taniguchi LU, Bierrenbach AL, Toscano CM, Schettino GP, Azevedo LC. Sepsis-related deaths in brazil: an analysis of the national mortality registry from 2002 to 2010. Crit Care. 2014;18:608. Lu TH, Anderson RN, Kawachi I. Trends in frequency of reporting improper diabetes-related cause-of-death statements on death certificates, 1985–2005: an algorithm to identify incorrect causal sequences. Am J Epidemiol. 2010;171:1069–78. Wang HE, Devereaux RS, Yealy DM, Safford MM, Howard G. National variation in United States sepsis mortality: a descriptive study. Int J Health Geogr. 2010;9:9. Boyle P, Parkin DM. Statistical methods for registries. In: Jensen OM, Parkin DM, Maclennan R, Muir CS, Skeet RG, editors. Cancer registration: principles and methods. Lyon: IARC Scientific Publications No. 95. International Agency for Research on Cancer; 1991. Walkey AJ, Lagu T, Lindenauer PK. Trends in sepsis and infection sources in the united states. A population-based study. Ann Am Thorac Soc. 2015;12:216–20. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228. Chen YC, Chang SC, Pu C, Tang GJ. The impact of nationwide education program on clinical practice in sepsis care and mortality of severe sepsis: a population-based study in Taiwan. PLoS One. 2013;8, e77414. Leligdowicz A, Dodek PM, Norena M, Wong H, Kumar A, Kumar A, Co-operative Antimicrobial Therapy of Septic Shock Database Research Group. Association between source of infection and hospital mortality in patients who have septic shock. Am J Respir Crit Care Med. 2014;189:1204–13.