Using hospital discharge data from five states over a seven-year period (1992, 1995 and 1999) and federal population and health care data, researchers determined that the annual rate of severe sepsis cases increased by 6.2 percent from 635,000 cases in 1992 to 965,000 cases in 1999. In addition, the study team observed a 6.9 percent annual increase in the number of complex severe sepsis cases, defined by more than one organ failure, treated in the ICU. They also noted a slight increase of 2.9 percent in the proportion of severe sepsis patients admitted to ICUs each year, although the overall proportion of ICU severe sepsis cases remained consistent for all years studied, at approximately 50 percent. Changes in the site of infection in sepsis cases in the study were relatively minor, the most notable being 4.4 percent increase in respiratory infections and a 2.5 percent decrease in urosepsis.
"The incessant growth of the severe sepsis epidemic in this country ought to be cause for grave alarm," said investigator Derek C. Angus, M.D., M.P.H., F.C.C.P., associate professor of critical care medicine, University of Pittsburgh School of Medicine. "This condition has long been one of medicine's greatest foes, taking more lives each year than breast, colorectal, pancreatic and prostate cancer combined. Mounting numbers and more complex cases will only make severe sepsis a more formidable adversary."
Although the annual incidence of severe sepsis cases increased overall by 6.2 percent, researchers noted a dramatic 40 percent increase in the number of elderly patients over 85 years of age with the condition. This shift resulted in a one-year increase in the average age of the American severe sepsis patient, from 63 to 64 years of age. However, despite the increases in patient age and case complexity, the study team found that, overall, sepsis-related mortality decreased slightly by approximately 4 percent over the seven-year period.
"This is the first time we've looked really closely at the changes in the actual patients who make up the towering mountain of severe sepsis statistics in this country," said Dr. Angus. "What we found is that the face of severe sepsis is, on the whole, getting older than it used to be. And yet recent improvements in critical care technology have meant some patients appear to have a better chance of evading this too-often-deadly stalker."
Although the decline in mortality associated with severe sepsis is welcome news, researchers conclude that the increasing complexity of patients' cases, coupled with the advancing age of the typical severe sepsis patient, may necessitate increased use of costly medical procedures to optimize patient survival – a cause for concern in today's health care cost-containment environment. A recent survey by the Society of Critical Care Medicine, in fact, revealed that attempting to control medical costs through so-called "bedside rationing" of services and medications is practiced by nearly two-thirds of critical care providers, and that 43 percent said they would ration the only FDA-approved drug for severe sepsis, drotrecogin alfa (activated), in order to control medical costs.
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