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Brazilian Sepsis Epidemiological Study (BASES study)

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Consistent data about the incidence and outcome of sepsis in Latin American intensive care units (ICUs), including Brazil, are lacking. This study was designed to verify the actual incidence density and outcome of sepsis in Brazilian ICUs. We also assessed the association between the Consensus Conference criteria and outcome Methods This is a multicenter observational cohort study performed in five private and public, mixed ICUs from two different regions of Brazil. We prospectively followed 1383 adult patients consecutively admitted to those ICUs from May 2001 to January 2002, until their discharge, 28th day of stay, or death. For all patients we collected the following data at ICU admission: age, gender, hospital and ICU admission diagnosis, APACHE II score, and associated underlying diseases. During the following days, we looked for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock criteria, as well as recording the sequential organ failure assessment score. Infection was diagnosed according to CDC criteria for nosocomial infection, and for community-acquired infection, clinical, radiological and microbiological parameters were used. Results For the whole cohort, median age was 65.2 years (49–76), median length of stay was 2 days (1–6), and the overall 28-day mortality rate was 21.8%. Considering 1383 patients, the incidence density rates for sepsis, severe sepsis and septic shock were 61.4, 35.6 and 30.0 per 1000 patient-days, respectively. The mortality rate of patients with SIRS, sepsis, severe sepsis and septic shock increased progressively from 24.3% to 34.7%, 47.3% and 52.2%, respectively. For patients with SIRS without infection the mortality rate was 11.3%. The main source of infection was lung/respiratory tract. Conclusion Our preliminary data suggest that sepsis is a major public health problem in Brazilian ICUs, with an incidence density about 57 per 1000 patient-days. Moreover, there was a close association between ACCP/SCCM categories and mortality rate.
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Available onlinehttp://ccforum.com/content/8/4/R251
August 2004 Vol 8 No 4 Open Access Research Brazilian Sepsis Epidemiological Study (BASES study) 1 2 3 3 Eliézer Silva , Marcelo de Almeida Pedro , Ana Cristina Beltrami Sogayar , Tatiana Mohovic , Carla Lika de 4 2 2 5 Oliveira Silva , Mariano Janiszewski , Ruy Guilherme Rodrigues Cal , Érica Fernandes de Sousa , 4 6 7 8 9 Thereza Phitoe Abe , Joel de Andrade , Jorge Dias de Matos , Ederlon Rezende , Murillo Assunção , 2 10 2 2 Álvaro Avezum , Patrícia CS Rocha , Gustavo Faissol Janot de Matos , André Moreira Bento , 11 12 13 Alice Danielli Corrêa , Paulo Cesar Bastos Vieira and Elias Knobel 1 Supervisor, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil; Associate Professor, Medical School, Santo Amaro University, São Paulo, Brazil 2 Staff Member, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil 3 Resident of Internal Medicine, Medical School, Santo Amaro University, São Paulo, Brazil 4 Research Nurse, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil 5 Fellow, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil 6 Head, Intensive Care Unit, University Hospital, Federal University of Santa Catarina, Florianopolis, Brazil 7 Staff Member, Intensive Care Unit, Hospital Governador Celso Ramos, Florianopolis, Brazil 8 Head, Intensive Care Unit, Hospital dos Servidores do Estado São Paulo, Brazil 9 Staff Member, Intensive Care Unit, Hospital dos Servidores do Estado, São Paulo, Brazil 10 Research Nurse, Intensive Care Unit, Medical School, Santo Amaro University, São Paulo, Brazil 11 Staff Member, Intensive Care Unit, University Hospital, Federal University of Santa Catarina, Florianopolis, Brazil 12 Head, Intensive Care Unit, Medical School, Santo Amaro University, São Paulo, Brazil 13 Head, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Corresponding author: Eliézer Silva, eliezer@einstein.br
Received: 13 February 2004
Revisions requested: 25 March 2004
Revisions received: 22 April 2004
Accepted: 21 May 2004
Published: 15 June 2004
Critical Care2004,8:R251R260 (DOI 10.1186/cc2892) This article is online at: http://ccforum.com/content/8/4/R251
© 2004 Silvaet al.; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
Abstract Introductiondata about the incidence and outcome of sepsis in Latin American intensive care units Consistent (ICUs), including Brazil, are lacking. This study was designed to verify the actual incidence density and outcome of sepsis in Brazilian ICUs. We also assessed the association between the Consensus Conference criteria and outcome MethodsThis is a multicenter observational cohort study performed in five private and public, mixed ICUs from two different regions of Brazil. We prospectively followed 1383 adult patients consecutively admitted to those ICUs from May 2001 to January 2002, until their discharge, 28th day of stay, or death. For all patients we collected the following data at ICU admission: age, gender, hospital and ICU admission diagnosis, APACHE II score, and associated underlying diseases. During the following days, we looked for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock criteria, as well as recording the sequential organ failure assessment score. Infection was diagnosed according to CDC criteria for nosocomial infection, and for communityacquired infection, clinical, radiological and microbiological parameters were used. ResultsFor the whole cohort, median age was 65.2 years (49–76), median length of stay was 2 days (1–6), and the overall 28day mortality rate was 21.8%. Considering 1383 patients, the incidence density rates for sepsis, severe sepsis and septic shock were 61.4, 35.6 and 30.0 per 1000 patientdays, respectively. The mortality rate of patients with SIRS, sepsis, severe sepsis and septic shock increased progressively from 24.3% to 34.7%, 47.3% and 52.2%, respectively. For patients with SIRS without infection the mortality rate was 11.3%. The main source of infection was lung/respiratory tract. Conclusion Our preliminary data suggest that sepsis is a major public health problem in Brazilian ICUs, with an incidence density about 57 per 1000 patientdays. Moreover, there was a close association between ACCP/SCCM categories and mortality rate.
Keywords:epidemiology, incidence, outcome, sepsis
ACCP/SCCM = American College of Chest Physicians/Society of Critical Care Medicine; APACHE = Acute Physiology and Chronic Health Evalu ation; CI = confidence interval; ICU = intensive care unit; IQR = interquartile range; LOS = length of stay; SIRS = systemic inflammatory response syndrome; SOFA = sequential organ failure assessment.
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