**Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*.**

Pubmed ID: 24201173

Pubmed Central ID: PMC4313930

Journal: Critical care medicine

Publication Date: March 1, 2014

Affiliation: 1The Pulmonary Center, Boston University School of Medicine, Boston, MA. 2Division of Pulmonary, Allergy, and Critical Care Medicine Internal Medicine, Boston Medical Center, Boston, MA. 3Department of Medicine, Boston Medical Center, Boston, MA. 4Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA. 5The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, NH.

MeSH Terms: Humans, Male, Adult, Female, Aged, United States, Middle Aged, Survival Analysis, Randomized Controlled Trials as Topic, Risk Assessment, Hospitalization, Cause of Death, Hospital Mortality, Time Factors, Sepsis, Inpatients, Shock, Septic

Grants: K07 CA138772, K01 HL116768, K01HL116768, K07138772, R21 HL112672

Authors: Walkey AJ, Wiener RS, Stevenson EK, Rubenstein AR, Radin GT

Cite As: Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med 2014 Mar;42(3):625-31.

Studies:

Acute Respiratory Distress Network (ARDSNet) Study 05 Fluid and Catheter Treatment Trial (FACTT)

Abstract

OBJECTIVES: Trends in severe sepsis mortality derived from administrative data may be biased by changing International Classification of Diseases, 9th Revision, Clinical Modification, coding practices. We sought to determine temporal trends in severe sepsis mortality using clinical trial data that does not rely on International Classification of Diseases, 9th Revision, Clinical Modifications coding and compare mortality trends in trial data with those observed from administrative data. DESIGN: We searched MEDLINE for multicenter randomized trials that enrolled patients with severe sepsis from 1991 to 2009. We calculated standardized mortality ratios for each trial from observed 28-day mortality of usual care participants and predicted mortality from severity-of-illness scores. To compare mortality trends from clinical trials to administrative data, we identified adult severe sepsis hospitalizations in the Nationwide Inpatient Sample, 1993-2009, using two previously validated algorithms. SETTING: In-patient. PATIENTS: Patients with severe sepsis or septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 3,244 potentially eligible articles, we included 36 multicenter severe sepsis trials, with a total of 14,418 participants in a usual care arm. Participants with severe sepsis receiving usual care had a 28-day mortality of 33.2%. Observed mortality decreased 3.0% annually (95% CI, 0.8%-5.0%; p = 0.009), decreasing from 46.9% (standardized mortality ratio 0.94; 95% CI, 0.86-1.03) during years 1991-1995 to 29% (standardized mortality ratio 0.53; 95% CI, 0.50-0.57) during years 2006-2009 (3.0% annual change). Trends in hospital mortality among patients with severe sepsis identified from administrative data (Angus definition, 4.7% annual change; 95% CI, 4.1%-5.3%; p = 0.69 and Martin definition, 3.5% annual change; 95% CI, 3.0%-4.1%; p = 0.97) were similar to trends identified from clinical trials. CONCLUSION: Since 1991, patients with severe sepsis enrolled in usual care arms of multicenter randomized trials have experienced decreasing mortality. The mortality trends identified in clinical trial participants appear similar to those identified using administrative data and support the use of administrative data to monitor mortality trends in patients with severe sepsis.