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Sepsis in European intensive care units: Results of the SOAP study*

Vincent, Jean-Louis MD, PhD, FCCM; Sakr, Yasser MB, BCh, MSc; Sprung, Charles L. MD; Ranieri, V Marco MD; Reinhart, Konrad MD, PhD; Gerlach, Herwig MD, PhD; Moreno, Rui MD, PhD; Carlet, Jean MD, PhD; Le Gall, Jean-Roger MD; Payen, Didier MD

doi: 10.1097/01.CCM.0000194725.48928.3A
Clinical Investigations

Objective: To better define the incidence of sepsis and the characteristics of critically ill patients in European intensive care units.

Design: Cohort, multiple-center, observational study.

Setting: One hundred and ninety-eight intensive care units in 24 European countries.

Patients: All new adult admissions to a participating intensive care unit between May 1 and 15, 2002.

Interventions: None.

Measurements and Main Results: Demographic data, comorbid diseases, and clinical and laboratory data were collected prospectively. Patients were followed up until death, until hospital discharge, or for 60 days. Of 3,147 adult patients, with a median age of 64 yrs, 1,177 (37.4%) had sepsis; 777 (24.7%) of these patients had sepsis on admission. In patients with sepsis, the lung was the most common site of infection (68%), followed by the abdomen (22%). Cultures were positive in 60% of the patients with sepsis. The most common organisms were Staphylococcus aureus (30%, including 14% methicillin-resistant), Pseudomonas species (14%), and Escherichia coli (13%). Pseudomonas species was the only microorganism independently associated with increased mortality rates. Patients with sepsis had more severe organ dysfunction, longer intensive care unit and hospital lengths of stay, and higher mortality rate than patients without sepsis. In patients with sepsis, age, positive fluid balance, septic shock, cancer, and medical admission were the important prognostic variables for intensive care unit mortality. There was considerable variation between countries, with a strong correlation between the frequency of sepsis and the intensive care unit mortality rates in each of these countries.

Conclusions: This large pan-European study documents the high frequency of sepsis in critically ill patients and shows a close relationship between the proportion of patients with sepsis and the intensive care unit mortality in the various countries. In addition to age, a positive fluid balance was among the strongest prognostic factors for death. Patients with intensive care unit acquired sepsis have a worse outcome despite similar severity scores on intensive care unit admission.

From the Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium (J-LV, YS); Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel (CLS); Department of Anesthesiology and Intensive Care, S. Giovanni Battista Hospital, University of Turin, Italy (VMR); Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University Jena, Germany (KR); Department of Anesthesiology and Intensive Care, Vivantes-Klinikum Neukölln, Berlin, Germany (HG); Department for Intensive Care, Hospital de St, Antonio dos Capuchos, Lisbon, Portugal (RM); Department of Intensive Care, Saint-Joseph Hospital, Paris, France (JC); Department of Intensive Care, Saint-Louis Hospital, Paris, France (J-RLG); and Department of Anesthesiology and Intensive Care, Centre Hospitalier Universitaire Lariboisiere, Paris, France (DP).

Endorsed by the European Society for Intensive Care Medicine and supported by unlimited grants from Abbott, Baxter, Eli Lilly, GlaxoSmithKline, and NovoNordisk.

Dr. Carlet has received speaking fees from Wyeth and has done numerous studies with Wyeth, Chiron, GSK, Lilly, Antrics, Intrabiotics, Fujisawa, and Bayer. The remaining authors have no financial interests to disclose.

© 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins