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Incidence Rate of Community-Acquired Sepsis Among Hospitalized Acute Medical Patients—A Population-Based Survey*

Henriksen, Daniel Pilsgaard MD, PhD1; Laursen, Christian B. MD, PhD2; Jensen, Thøger Gorm MD, PhD3; Hallas, Jesper MD, DMSci4; Pedersen, Court MD, DMSci5; Lassen, Annmarie Touborg MD, PhD, DMSci1

doi: 10.1097/CCM.0000000000000611
Feature Articles

Objective: Sepsis is a frequent cause of admission, but incidence rates based on administrative data have previously produced large differences in estimates. The aim of the study was to estimate the incidence of community-acquired sepsis based on patients’ symptoms and clinical findings at arrival to the hospital.

Design: Population-based survey.

Setting: Medical emergency department from September 1, 2010, to August 31, 2011.

Patients: All patients were manually reviewed using a structured protocol in order to identify the presence of infection. Vital signs and laboratory values were collected to define the presence of systemic inflammatory response syndrome and organ dysfunction.

Measurements and Main Results: Incidence rate of sepsis of any severity. Among 8,358 admissions to the medical emergency department, 1,713 patients presented with an incident admission of sepsis of any severity, median age 72 years (5–95%; range, 26–91 yr), 793 (46.3%) were men, 728 (42.5%) presented with a Charlson comorbidity index greater than 2,621 (36.3%) were admitted with sepsis, 1,071 (62.5%) with severe sepsis, and 21 (1.2%) with septic shock. Incidence rate was 731/100,000 person-years at risk (95% CI, 697–767) in patients with sepsis of any severity, 265/100,000 person-years at risk (95% CI, 245–287) in patients with sepsis, 457/100,000 person-years at risk (95% CI, 430–485) in patients with severe sepsis, and 9/100,000 person-years at risk (95% CI, 6–14) in patients with septic shock.

Conclusions: Based on symptoms and clinical findings at arrival, incidence rates of patients admitted to a medical emergency department with sepsis and severe sepsis are more frequent than previously reported based on discharge diagnoses.

1Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.

2Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.

3Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark.

4Department of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark.

5Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.

* See also p. 226.

This work was performed at The Medical Emergency Department, Odense University Hospital, Denmark, in the period September 2010 to August 2011.

Dr. Henriksen conceived the study, participated in the design of the study, did the statistical analysis, participated in the analysis, retrieved and checked data and interpretation of data, and drafted the article. Drs. Laursen and Pedersen participated in the design of the study and interpretation of data and revised the article critically. Drs. Jensen and Hallas participated in the design of the study and interpretation of data, provided data from two databases, and revised the article critically. Dr. Lassen conceived the study, participated in the design of the study, retrieved and checked data, and revised the article critically. All authors have read and approved the final article. Drs. Henriksen and Lassen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Henriksen is the guarantor.

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Supported, in part, by University of Southern Denmark, The Research Foundation of Odense University Hospital, as well as an unrestricted grant from the philanthropically private fund TrygFonden given to the University of Southern Denmark.

Dr. Jensen received support for travel for meeting expenses (travel expenses, hotel accommodations, and conference fees for a conference about fungal infections covered by Merck [MSD]). Dr. Pedersen served as board member for Gilead; lectured for Abbott, GlaxoSmithKline, and MSD; and received support for travel (conference, support for fee, hotel, and travel costs). His institution received grant support from Gilead (unrestricted research grant). Dr. Lassen received grant support from the Tryg Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2015 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins