Infectious Disease

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Outcomes of the Surviving Sepsis Campaign in the ICU in the USA and Europe

 

Mortality from severe sepsis and septic shock differs across continents, countries, and regions. As a result, a study published in Lancet Infectious Diseases (2012;12:919-924) used data from the Surviving Sepsis Campaign (SSC) to compare models of care and outcomes for patients with severe sepsis and septic shock in the US and Europe.

 

The SSC was introduced into more than 200 sites in Europe and the USA. All patients presenting with severe sepsis and septic shock 1) in emergency departments or hospital wards, and admitted to intensive care units (ICUs), and 2) those with sepsis in ICUs were entered into the SSC database. Patients included in the cohort were limited to those entered in the first 4 years at every site. Random-effects logistic regression was used to estimate the hospital mortality odds ratio (OR) for Europe relative to the US and to find the relation between lengths of stay in hospital and ICU and geographic region.

 

A total of 25,375 patients were included in the study. The US included 107 sites with 18,766 (74%) patients, and Europe included 79 hospital sites with 6,609 (26%) patients. In the US, 12,218 (65·1%) were admitted to the ICU from the emergency department whereas in Europe, 3405 (51·5%) were admitted from the wards. The median stay on the hospital wards before ICU admission was longer in Europe than in the USA (1.0 vs 0.1 days). Raw hospital mortality was higher in Europe than in the USA (41.1% vs 28.3%. The median length of stay in ICU (7.8 vs 4.2) and hospital (22.8 vs 10.5 days) was longer in Europe than in the USA. However, adjusted mortality in Europe was not significantly higher than that in the USA (32.3% vs 31.3%; p=0·468). Complete compliance with all applicable elements of the sepsis resuscitation bundle was higher in the USA than in Europe (21.6% vs 18.4%).

 

According to the authors, the significant difference in unadjusted mortality and the fact that this difference disappears with severity adjustment raise important questions about the effect of the approach to critical care in Europe compared with that in the US, and the effect of ICU bed availability on outcomes in patients with severe sepsis and septic shock requires further investigation.

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