17 - SIRS, sepsis and multiorgan failure

Summary

EPIDEMIOLOGY

Sepsis remains a common reason for intensive care unit (ICU) admission and is a leading cause of mortality. This disease is now recognized to be a time-sensitive emergency, because patients stand the best chance for survival when effective therapeutic interventions are delivered as early as possible. However, consistent data are lacking regarding the incidence and outcome of sepsis in ICUs globally. Data extrapolated from a cohort study conducted by Finfer et al in 2004 across twenty three closed multidisciplinary ICUs showed that the incidence of severe sepsis among adult patients was 0.77 patients per 1000 population (95% CI, 0.76–0.79). There were 752 episodes of severe sepsis identified in 691 patients, equating to 11.8 patients with severe sepsis per 100 ICU admissions (95% CI, 10.9–12.6). The EPISEPSIS study group conducted a nationwide, prospective, multicentre survey of patients with severe sepsis in 206 French ICUs over two consecutive weeks. They estimated the incidence of severe sepsis to be 0.95 cases per 1000 in the French population. In the United States between 1979 and 2000 an annualized increase of 8.7% in the incidence of sepsis was noted. (From about 164,000 cases (0.82 per 1000 population) to nearly 660,000 cases (2.4 per 1000 population)).

Sepsis is estimated to affect 18 million people worldwide each year and kill 1400 people each day. According to an epidemiological study, sepsis affects about 700,000 people annually in the United States alone, with an overall mortality rate of 30%, or more than 50% in patients with septic shock and/or multiple system organ failure.