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High European mortality rates compared to US raise questions about sepsis care

October 24, 2012

Severe sepsis is a life-threatening illness caused by the immune system over-reacting to an infection, and it may develop into septic shock if allowed to progress, interfering with the function of the body's vital organs and causing a dangerous drop in blood pressure. Approximately 30% of people who acquire severe sepsis die as a result of the condition. Around 30 000 cases of severe sepsis are thought to occur in the UK every year, and the number seems to be rising.*

An international team of researchers studied records of more than 25 000 patients with severe sepsis or septic shock in 186 sites across the USA and Europe. They found that there were 12% more deaths from sepsis-related causes in European hospitals, although when these data were adjusted for factors such as the origin of the sepsis and type of organ failure, the difference in mortality rates between the USA and Europe was not significant.

The study, which is the first ever to directly compare outcomes between the USA and Europe in patients with severe sepsis and septic shock, was designed to assess whether hospitals were complying with international targets and guidelines for sepsis care, referred to collectively as the Surviving Sepsis Campaign. However, secondary outcomes of the study included hospital mortality, length of stay in hospital and length of stay in Intensive Care (ICU), and the researchers found striking disparities between each of these indicators.

In the USA, the majority (65%) of patients were admitted to ICU from the emergency department, whereas in Europe, just over half (52%) of patients were admitted to ICU from general wards. Patients tended to stay in ICU for longer in Europe, with the average length of stay being 1 day, compared to just a few hours (0.1 days) in the USA.

The researchers say that the difference in unadjusted average mortality rates between the two continents does not necessarily reflect a poorer standard of care in European Hospitals, but could simply reflect different approaches to critical care, whereby European patients tend to be admitted to ICU when they are sicker, and therefore more likely to die.

However, according to lead author Professor Mitchell Levy, at Rhode Island Hospital and The Warren Alpert Medical School of Brown University, USA, "These results raise important questions about the effect of the approach to critical care in Europe compared with that in the USA. Given the higher number of ICU beds per head in the USA than in Europe, more patients with less serious cases of sepsis might be admitted to the ICU. However, this is not at all clear from existing research, and further investigation is urgently needed if we are to be able to accurately monitor, and ultimately improve, sepsis care."**

In a linked Comment, Dr Julian Bion at the Queen Elizabeth Hospital, Birmingham, UK, writes that "The investigators identified important international differences in processes and outcomes of care, which, taken together, provide a convincing argument for the need to address variation in structure and process to reduce mortality from this lethal and complex disease."
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NOTES TO EDITORS:

* Source: NHS Choices - Sepsis http://www.nhs.uk/conditions/Blood-poisoning/Pages/Introduction.aspx?url=Pages/What-is-it.aspx (accessed October 18, 2012)

** Quote direct from author and cannot be found in text of Article.

Lancet

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