Two Decades of Mortality Trends among Patients with Severe Sepsis: A Comparative Meta-analysis
By E. Stevenson, A. Rubenstein, Gregory T Radin, R. Wiener, A. Walkey. Critical Care Medicine, 2014
636 citations recorded by the source corpus.
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.
Subfields: Critical Care and Intensive Care Medicine, Epidemiology, Public Health, Environmental and Occupational Health
View Paper: https://www.semanticscholar.org/paper/228895d978750acfd4574348bad44e11a71febba
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In Critical Care and Intensive Care Medicine
In Epidemiology
Citations in the corpus
- The demise of early goal‐directed therapy for severe sepsis and septic shock (2015, background): “analyzed the mortality trend for patients with severe sepsis or septic shock in the United States from 1991 to 2009.(53) During this time period, there was a linear fall in mortality from 46.”
- Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019— results from a systematic review and meta-analysis (2020, background): “tality rates from clinical studies and administrative sources were similar for the US in the given time period from 1991 to 2009 [8].”