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Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019- results from a systematic review and meta-analysis.
Crit Care. 2020 05 19; 24(1):239.CC

Abstract

BACKGROUND

Sepsis and septic shock remain drivers for mortality in critically ill patients. The heterogeneity of the syndrome hinders the generation of reproducible numbers on mortality risks. Consequently, mortality rates range from 15 to 56%. We aimed to update and extend the existing knowledge from meta-analyses and estimate 30- and 90-day mortality rates for sepsis and septic shock separately, stratify rates by region and study type and assess mortality rates across different sequential organ failure assessment (SOFA) scores.

METHODS

We performed a systematic review of articles published in PubMed or in the Cochrane Database, between 2009 and 2019 in English language including interventional and observational studies. A meta-analysis of pooled 28/30- and 90-day mortality rated separately for sepsis and septic shock was done using a random-effects model. Time trends were assessed via Joinpoint methodology and for the assessment of mortality rate over different SOFA scores, and linear regression was applied.

RESULTS

Four thousand five hundred records were identified. After title/abstract screening, 783 articles were assessed in full text for eligibility. Of those, 170 studies were included. Average 30-day septic shock mortality was 34.7% (95% CI 32.6-36.9%), and 90-day septic shock mortality was 38.5% (95% CI 35.4-41.5%). Average 30-day sepsis mortality was 24.4% (95% CI 21.5-27.2%), and 90-day sepsis mortality was 32.2% (95% CI 27.0-37.5%). Estimated mortality rates from RCTs were below prospective and retrospective cohort studies. Rates varied between regions, with 30-day septic shock mortality being 33.7% (95% CI 31.5-35.9) in North America, 32.5% (95% CI 31.7-33.3) in Europe and 26.4% (95% CI 18.1-34.6) in Australia. A statistically significant decrease of 30-day septic shock mortality rate was found between 2009 and 2011, but not after 2011. Per 1-point increase of the average SOFA score, average mortality increased by 1.8-3.3%.

CONCLUSION

Trends of lower sepsis and continuous septic shock mortality rates over time and regional disparities indicate a remaining unmet need for improving sepsis management. Further research is needed to investigate how trends in the burden of disease influence mortality rates in sepsis and septic shock at 30- and 90-day mortality over time.

Authors+Show Affiliations

Universitätsklinikum Jena, Klinik für Anästhesiologie und Intensivmedizin, Am Klinikum 1, 07747, Jena, Germany. Michael.Bauer@med.uni-jena.de.Vivantes Klinikum Neukölln, Rudower Straβe 48, 12351, Berlin, Germany.LinkCare GmbH, Kyffhäuserstr. 64, 70469, Stuttgart, Germany.CytoSorbents Europe GmbH, Müggelseedamm 131, 12587, Berlin, Germany.LinkCare GmbH, Kyffhäuserstr. 64, 70469, Stuttgart, Germany.CytoSorbents Europe GmbH, Müggelseedamm 131, 12587, Berlin, Germany.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

32430052

Citation

Bauer, Michael, et al. "Mortality in Sepsis and Septic Shock in Europe, North America and Australia Between 2009 and 2019- Results From a Systematic Review and Meta-analysis." Critical Care (London, England), vol. 24, no. 1, 2020, p. 239.
Bauer M, Gerlach H, Vogelmann T, et al. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019- results from a systematic review and meta-analysis. Crit Care. 2020;24(1):239.
Bauer, M., Gerlach, H., Vogelmann, T., Preissing, F., Stiefel, J., & Adam, D. (2020). Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019- results from a systematic review and meta-analysis. Critical Care (London, England), 24(1), 239. https://doi.org/10.1186/s13054-020-02950-2
Bauer M, et al. Mortality in Sepsis and Septic Shock in Europe, North America and Australia Between 2009 and 2019- Results From a Systematic Review and Meta-analysis. Crit Care. 2020 05 19;24(1):239. PubMed PMID: 32430052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019- results from a systematic review and meta-analysis. AU - Bauer,Michael, AU - Gerlach,Herwig, AU - Vogelmann,Tobias, AU - Preissing,Franziska, AU - Stiefel,Julia, AU - Adam,Daniel, Y1 - 2020/05/19/ PY - 2020/01/28/received PY - 2020/05/07/accepted PY - 2020/5/21/entrez PY - 2020/5/21/pubmed PY - 2021/1/14/medline KW - Meta-analysis KW - Mortality KW - SOFA KW - Sepsis KW - Septic shock KW - Trend SP - 239 EP - 239 JF - Critical care (London, England) JO - Crit Care VL - 24 IS - 1 N2 - BACKGROUND: Sepsis and septic shock remain drivers for mortality in critically ill patients. The heterogeneity of the syndrome hinders the generation of reproducible numbers on mortality risks. Consequently, mortality rates range from 15 to 56%. We aimed to update and extend the existing knowledge from meta-analyses and estimate 30- and 90-day mortality rates for sepsis and septic shock separately, stratify rates by region and study type and assess mortality rates across different sequential organ failure assessment (SOFA) scores. METHODS: We performed a systematic review of articles published in PubMed or in the Cochrane Database, between 2009 and 2019 in English language including interventional and observational studies. A meta-analysis of pooled 28/30- and 90-day mortality rated separately for sepsis and septic shock was done using a random-effects model. Time trends were assessed via Joinpoint methodology and for the assessment of mortality rate over different SOFA scores, and linear regression was applied. RESULTS: Four thousand five hundred records were identified. After title/abstract screening, 783 articles were assessed in full text for eligibility. Of those, 170 studies were included. Average 30-day septic shock mortality was 34.7% (95% CI 32.6-36.9%), and 90-day septic shock mortality was 38.5% (95% CI 35.4-41.5%). Average 30-day sepsis mortality was 24.4% (95% CI 21.5-27.2%), and 90-day sepsis mortality was 32.2% (95% CI 27.0-37.5%). Estimated mortality rates from RCTs were below prospective and retrospective cohort studies. Rates varied between regions, with 30-day septic shock mortality being 33.7% (95% CI 31.5-35.9) in North America, 32.5% (95% CI 31.7-33.3) in Europe and 26.4% (95% CI 18.1-34.6) in Australia. A statistically significant decrease of 30-day septic shock mortality rate was found between 2009 and 2011, but not after 2011. Per 1-point increase of the average SOFA score, average mortality increased by 1.8-3.3%. CONCLUSION: Trends of lower sepsis and continuous septic shock mortality rates over time and regional disparities indicate a remaining unmet need for improving sepsis management. Further research is needed to investigate how trends in the burden of disease influence mortality rates in sepsis and septic shock at 30- and 90-day mortality over time. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/32430052/Mortality_in_sepsis_and_septic_shock_in_Europe_North_America_and_Australia_between_2009_and_2019__results_from_a_systematic_review_and_meta_analysis_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02950-2 DB - PRIME DP - Unbound Medicine ER -