Skip to main content
Top
Published in: Critical Care 6/2014

Open Access 01-12-2014 | Research

Sepsis-related deaths in Brazil: an analysis of the national mortality registry from 2002 to 2010

Authors: Leandro U Taniguchi, Ana Luiza Bierrenbach, Cristiana M Toscano, Guilherme PP Schettino, Luciano CP Azevedo

Published in: Critical Care | Issue 6/2014

Login to get access

Abstract

Introduction

Limited population-based epidemiologic information about sepsis’ demography, including its mortality and temporal changes is available from developing countries. We investigated the epidemiology of sepsis deaths in Brazil using secondary data from the Brazilian Mortality Information System.

Methods

Retrospective descriptive analysis of Brazilian multiple-cause-of-death data between 2002 and 2010, with sepsis-associated International Classification of Diseases, 10th Revision (ICD-10) code indicated as the cause of death. Population-based sepsis associated mortality rates and trends were estimated. Annual population-based mortality rates were calculated using age-stratified population estimates from the 2010 census provided by the Brazilian Institute of Geography and Statistics as denominators.

Results

The total number of annual deaths recorded in Brazil increased over the decade, from 982,294 deaths reported in 2002 to 1,133,761 deaths reported in 2010. The number of sepsis associated deaths also increased both in absolute numbers and proportions from 95,972 (9.77% of total deaths) in 2002 to 186,712 deaths (16.46%) in 2010. The age-adjusted rate of sepsis-associated mortality increased from 69.5 deaths per 100,000 to 97.8 deaths per 100,000 population from 2002 to 2010 (P <0.001). Sepsis-associated mortality was higher in individuals older than 60 years of age as compared to subjects aged 0 to 20 years (adjusted rate ratio 15.7 (95% confidence interval (CI) 15.6 to 15.8)) and in male subjects (1.15 (95% CI 1.15 to 1.16)).

Conclusions

Between 2002 and 2010 the contribution of sepsis to all cause mortality as reported in multiple-cause-of-death forms increased significantly in Brazil. Age-adjusted mortality rates by sepsis also increased in the last decade. Our results confirm the importance of sepsis as a significant healthcare issue in Brazil.
Appendix
Available only for authorised users
Literature
1.
go back to reference Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003, 348: 1546-1554. 10.1056/NEJMoa022139.CrossRef Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003, 348: 1546-1554. 10.1056/NEJMoa022139.CrossRef
2.
go back to reference Annane D, Aegerter P, Jars-Guincestre MC, Guidet B: Current epidemiology of septic shock: The CUB-Rea Network. Am J Respir Crit Care Med. 2003, 168: 165-172. 10.1164/rccm.2201087.CrossRef Annane D, Aegerter P, Jars-Guincestre MC, Guidet B: Current epidemiology of septic shock: The CUB-Rea Network. Am J Respir Crit Care Med. 2003, 168: 165-172. 10.1164/rccm.2201087.CrossRef
3.
go back to reference Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK: Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. 2012, 40: 754-761. 10.1097/CCM.0b013e318232db65.CrossRef Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK: Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. 2012, 40: 754-761. 10.1097/CCM.0b013e318232db65.CrossRef
4.
go back to reference Angus DC, Lind-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001, 29: 1303-1310. 10.1097/00003246-200107000-00002.CrossRef Angus DC, Lind-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001, 29: 1303-1310. 10.1097/00003246-200107000-00002.CrossRef
5.
go back to reference Dombrovskiy VY, Martin AA, Sunderram J, Paz HL: Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003. Crit Care Med. 2007, 35: 1244-1250. 10.1097/01.CCM.0000261890.41311.E9.CrossRef Dombrovskiy VY, Martin AA, Sunderram J, Paz HL: Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003. Crit Care Med. 2007, 35: 1244-1250. 10.1097/01.CCM.0000261890.41311.E9.CrossRef
6.
go back to reference Melamed A, Sorvillo FJ: The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care. 2009, 13: R28-10.1186/cc7733.CrossRef Melamed A, Sorvillo FJ: The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care. 2009, 13: R28-10.1186/cc7733.CrossRef
7.
go back to reference van Gestel A, Bakker J, Veraart CPWM, van Hout BA: Prevalence and incidence of severe sepsis in Dutch intensive care units. Crit Care. 2004, 8: R153-R162. 10.1186/cc2858.CrossRef van Gestel A, Bakker J, Veraart CPWM, van Hout BA: Prevalence and incidence of severe sepsis in Dutch intensive care units. Crit Care. 2004, 8: R153-R162. 10.1186/cc2858.CrossRef
8.
go back to reference Flaatten H: Epidemiology of sepsis in Norway in 1999. Crit Care. 2004, 8: R180-R184. 10.1186/cc2867.CrossRef Flaatten H: Epidemiology of sepsis in Norway in 1999. Crit Care. 2004, 8: R180-R184. 10.1186/cc2867.CrossRef
9.
go back to reference Linde-Zwirble WT, Angus DC: Severe sepsis epidemiology: sampling, selection, and society. Crit Care. 2004, 8: 222-226. 10.1186/cc2917.CrossRef Linde-Zwirble WT, Angus DC: Severe sepsis epidemiology: sampling, selection, and society. Crit Care. 2004, 8: 222-226. 10.1186/cc2917.CrossRef
10.
go back to reference Silva E, Pedro MA, Sogayar ACB, Mohovic T, Silva CLO, Janiszewski M, Cal RGR, Sousa EF, Abe TP, Andrade J, Matos JD, Rezende E, Assunção M, Avezum A, Rocha PCS, Matos GFJ, Bento AM, Corrêa AD, Vieira PCB, Knobel E: Brazilian Sepsis Epidemiological Study (BASES study). Crit Care. 2004, 8: R251-R260. 10.1186/cc2892.CrossRef Silva E, Pedro MA, Sogayar ACB, Mohovic T, Silva CLO, Janiszewski M, Cal RGR, Sousa EF, Abe TP, Andrade J, Matos JD, Rezende E, Assunção M, Avezum A, Rocha PCS, Matos GFJ, Bento AM, Corrêa AD, Vieira PCB, Knobel E: Brazilian Sepsis Epidemiological Study (BASES study). Crit Care. 2004, 8: R251-R260. 10.1186/cc2892.CrossRef
11.
go back to reference Cheng B, Xie G, Yao S, Wu X, Guo Q, Gu M, Fang Q, Xu Q, Wang D, Jin Y, Yuan S, Wang J, Du Z, Sun Y, Fang X: Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China. Crit Care Med. 2007, 35: 2538-2546. 10.1097/01.CCM.0000284492.30800.00.CrossRef Cheng B, Xie G, Yao S, Wu X, Guo Q, Gu M, Fang Q, Xu Q, Wang D, Jin Y, Yuan S, Wang J, Du Z, Sun Y, Fang X: Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China. Crit Care Med. 2007, 35: 2538-2546. 10.1097/01.CCM.0000284492.30800.00.CrossRef
12.
go back to reference Shen HN, Lu CL, Yang HH: Epidemiologic trend of severe sepsis in Taiwan from 1997 through 2006. Chest. 2010, 138: 298-304. 10.1378/chest.09-2205.CrossRef Shen HN, Lu CL, Yang HH: Epidemiologic trend of severe sepsis in Taiwan from 1997 through 2006. Chest. 2010, 138: 298-304. 10.1378/chest.09-2205.CrossRef
13.
go back to reference Záhorec R, Firment J, Straková J, Mikula J, Malík P, Novák I, Zeman J, Chlebo P: Epidemiology of severe sepsis in intensive care units in the Slovak Republic. Infection. 2005, 33: 122-128. 10.1007/s15010-005-4019-2.CrossRef Záhorec R, Firment J, Straková J, Mikula J, Malík P, Novák I, Zeman J, Chlebo P: Epidemiology of severe sepsis in intensive care units in the Slovak Republic. Infection. 2005, 33: 122-128. 10.1007/s15010-005-4019-2.CrossRef
14.
go back to reference Khwannimit B, Bhurayanontachai R: The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiol Infect. 2009, 137: 1333-1341. 10.1017/S0950268809002027.CrossRef Khwannimit B, Bhurayanontachai R: The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiol Infect. 2009, 137: 1333-1341. 10.1017/S0950268809002027.CrossRef
15.
go back to reference Rodríguez F, Barrera L, De La Rosa G, Dennis R, Dueñas C, Granados M, Londoño D, Molina F, Ortiz G, Jaimes F: The epidemiology of sepsis in Colombia: a prospective multicenter cohort study in ten university hospitals. Crit Care Med. 2011, 39: 1675-1682. 10.1097/CCM.0b013e318218a35e.CrossRef Rodríguez F, Barrera L, De La Rosa G, Dennis R, Dueñas C, Granados M, Londoño D, Molina F, Ortiz G, Jaimes F: The epidemiology of sepsis in Colombia: a prospective multicenter cohort study in ten university hospitals. Crit Care Med. 2011, 39: 1675-1682. 10.1097/CCM.0b013e318218a35e.CrossRef
16.
go back to reference Jawad I, Luksic I, Rafnsson SB: Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Glob Health. 2012, 2: 10404-10.7189/jogh.01.010404.CrossRef Jawad I, Luksic I, Rafnsson SB: Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Glob Health. 2012, 2: 10404-10.7189/jogh.01.010404.CrossRef
18.
go back to reference Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lindicker J, Angus D: The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2003, 167: 695-701. 10.1164/rccm.200207-682OC.CrossRef Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lindicker J, Angus D: The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2003, 167: 695-701. 10.1164/rccm.200207-682OC.CrossRef
19.
go back to reference Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013, 41: 580-637. 10.1097/CCM.0b013e31827e83af.CrossRef Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013, 41: 580-637. 10.1097/CCM.0b013e31827e83af.CrossRef
20.
go back to reference Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, Schorr C, Artigas A, Ramsay G, Beale R, Parker MM, Gerlach H, Reinhart K, Silva E, Harvey M, Regan S, Angus DC: The Surviving Sepsis Campaign: Results of an international guideline based performance improvement program targeting severe sepsis. Crit Care Med. 2010, 38: 367-374. 10.1097/CCM.0b013e3181cb0cdc.CrossRef Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, Schorr C, Artigas A, Ramsay G, Beale R, Parker MM, Gerlach H, Reinhart K, Silva E, Harvey M, Regan S, Angus DC: The Surviving Sepsis Campaign: Results of an international guideline based performance improvement program targeting severe sepsis. Crit Care Med. 2010, 38: 367-374. 10.1097/CCM.0b013e3181cb0cdc.CrossRef
21.
go back to reference Noritomi DT, Ranzani OT, Monteiro MB, Ferreira EM, Santos SR, Leibel F, Machado FR: Implementation of a multifaceted sepsis education program in an emerging country setting: clinical outcomes and cost-effectiveness in a long-term follow-up study. Intensive Care Med. 2014, 40: 182-191. 10.1007/s00134-013-3131-5.CrossRef Noritomi DT, Ranzani OT, Monteiro MB, Ferreira EM, Santos SR, Leibel F, Machado FR: Implementation of a multifaceted sepsis education program in an emerging country setting: clinical outcomes and cost-effectiveness in a long-term follow-up study. Intensive Care Med. 2014, 40: 182-191. 10.1007/s00134-013-3131-5.CrossRef
22.
go back to reference Sales JAL, David CM, Hatum R, Souza PCSP, Japiassú A, Pinheiro CTS, Friedman G, Silva OB, Dias MD, Koterba E, Dias FS, Piras C, Luiz RR: An epidemiological study of sepsis in intensive care units. Sepsis Brazil Study Rev Bras Ter Intensiva. 2006, 18: 9-17. 10.1590/S0103-507X2006000100003.CrossRef Sales JAL, David CM, Hatum R, Souza PCSP, Japiassú A, Pinheiro CTS, Friedman G, Silva OB, Dias MD, Koterba E, Dias FS, Piras C, Luiz RR: An epidemiological study of sepsis in intensive care units. Sepsis Brazil Study Rev Bras Ter Intensiva. 2006, 18: 9-17. 10.1590/S0103-507X2006000100003.CrossRef
23.
go back to reference Sogayar AMC, Machado FR, Rea-Neto A, Dornas A, Grion CMC, Lobo SMA, Tura BR, Silva CLO, Cal RGR, Beer I, Michels V, Safi J, Kayath M, Silva E: A multicentre, prospective study to evaluate costs of septic patients in Brazilian intensive care units. Pharmacoeconomics. 2008, 26: 425-434. 10.2165/00019053-200826050-00006.CrossRef Sogayar AMC, Machado FR, Rea-Neto A, Dornas A, Grion CMC, Lobo SMA, Tura BR, Silva CLO, Cal RGR, Beer I, Michels V, Safi J, Kayath M, Silva E: A multicentre, prospective study to evaluate costs of septic patients in Brazilian intensive care units. Pharmacoeconomics. 2008, 26: 425-434. 10.2165/00019053-200826050-00006.CrossRef
24.
go back to reference Rezende E, Silva JM, Isola AM, Campos EV, Amendola CP, Almeida SL: Epidemiology of severe sepsis in the emergency department and difficulties in the initial assistance. Clinics. 2008, 63: 457-464. 10.1590/S1807-59322008000400008.CrossRef Rezende E, Silva JM, Isola AM, Campos EV, Amendola CP, Almeida SL: Epidemiology of severe sepsis in the emergency department and difficulties in the initial assistance. Clinics. 2008, 63: 457-464. 10.1590/S1807-59322008000400008.CrossRef
25.
go back to reference Beale R, Reinhart K, Brunkhorst FM, Dobb G, Levy M, Martin G, Martin C, Ramsey G, Silva E, Vallet B, Vincent JL, Janes JM, Sarwat S, Williams MD: Promoting global research excellence in severe sepsis (PROGRESS): Lessons from an International Sepsis Registry. Infection. 2009, 37: 222-232. 10.1007/s15010-008-8203-z.CrossRef Beale R, Reinhart K, Brunkhorst FM, Dobb G, Levy M, Martin G, Martin C, Ramsey G, Silva E, Vallet B, Vincent JL, Janes JM, Sarwat S, Williams MD: Promoting global research excellence in severe sepsis (PROGRESS): Lessons from an International Sepsis Registry. Infection. 2009, 37: 222-232. 10.1007/s15010-008-8203-z.CrossRef
26.
go back to reference McPherson D, Griffiths C, Williams M, Baker A, Klodawski E, Jacobson B, Donaldson L: Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010. BMJ Open. 2013, 3: e002586-10.1136/bmjopen-2013-002586.CrossRef McPherson D, Griffiths C, Williams M, Baker A, Klodawski E, Jacobson B, Donaldson L: Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010. BMJ Open. 2013, 3: e002586-10.1136/bmjopen-2013-002586.CrossRef
27.
go back to reference Rhee C, Gohil S, Klompas M: Regulatory mandates for sepsis care - reasons for caution. N Engl J Med. 2014, 370: 1673-1676. 10.1056/NEJMp1400276.CrossRef Rhee C, Gohil S, Klompas M: Regulatory mandates for sepsis care - reasons for caution. N Engl J Med. 2014, 370: 1673-1676. 10.1056/NEJMp1400276.CrossRef
28.
go back to reference Govindan S, Shapiro L, Langa KM, Iwashyna TJ: Death certificates underestimate infections as proximal causes of death in the U.S. PLoS One. 2014, 9: e97714-10.1371/journal.pone.0097714.CrossRef Govindan S, Shapiro L, Langa KM, Iwashyna TJ: Death certificates underestimate infections as proximal causes of death in the U.S. PLoS One. 2014, 9: e97714-10.1371/journal.pone.0097714.CrossRef
29.
go back to reference Iwashyna TJ, Odden A, Rohde J, Bonham C, Kuhn L, Malani P, Chen L, Flanders S: Identifying patients with severe sepsis using administrative claims: patient-level validation of the Angus Implementation of the International Consensus Conference Definition of Severe Sepsis. Med Care. 2014, 52: e39-e43. 10.1097/MLR.0b013e318268ac86.CrossRef Iwashyna TJ, Odden A, Rohde J, Bonham C, Kuhn L, Malani P, Chen L, Flanders S: Identifying patients with severe sepsis using administrative claims: patient-level validation of the Angus Implementation of the International Consensus Conference Definition of Severe Sepsis. Med Care. 2014, 52: e39-e43. 10.1097/MLR.0b013e318268ac86.CrossRef
30.
go back to reference Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, Iwashyna TJ: Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014, 312: 90-92. 10.1001/jama.2014.5804.CrossRef Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, Iwashyna TJ: Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014, 312: 90-92. 10.1001/jama.2014.5804.CrossRef
Metadata
Title
Sepsis-related deaths in Brazil: an analysis of the national mortality registry from 2002 to 2010
Authors
Leandro U Taniguchi
Ana Luiza Bierrenbach
Cristiana M Toscano
Guilherme PP Schettino
Luciano CP Azevedo
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-014-0608-8

Other articles of this Issue 6/2014

Critical Care 6/2014 Go to the issue