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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study

Authors: Toshikazu Abe, Hiroshi Ogura, Atsushi Shiraishi, Shigeki Kushimoto, Daizoh Saitoh, Seitaro Fujishima, Toshihiko Mayumi, Yasukazu Shiino, Taka-aki Nakada, Takehiko Tarui, Toru Hifumi, Yasuhiro Otomo, Kohji Okamoto, Yutaka Umemura, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin-ichiro Shiraishi, Kiyotsugu Takuma, Ryosuke Tsuruta, Akiyoshi Hagiwara, Kazuma Yamakawa, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Satoshi Fujimi, Satoshi Gando, on behalf of JAAM FORECAST group

Published in: Critical Care | Issue 1/2018

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Abstract

Background

Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan.

Methods

This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria.

Results

In total, 1184 patients (median age 73 years, interquartile range (IQR) 64–81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6–11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21–26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12–46) days. Approximately 37% of the patients were discharged home after recovery.

Conclusion

Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan.

Trial registration

UMIN-CTR, UMIN000019742. Registered on 16 November 2015.
Appendix
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Metadata
Title
Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study
Authors
Toshikazu Abe
Hiroshi Ogura
Atsushi Shiraishi
Shigeki Kushimoto
Daizoh Saitoh
Seitaro Fujishima
Toshihiko Mayumi
Yasukazu Shiino
Taka-aki Nakada
Takehiko Tarui
Toru Hifumi
Yasuhiro Otomo
Kohji Okamoto
Yutaka Umemura
Joji Kotani
Yuichiro Sakamoto
Junichi Sasaki
Shin-ichiro Shiraishi
Kiyotsugu Takuma
Ryosuke Tsuruta
Akiyoshi Hagiwara
Kazuma Yamakawa
Tomohiko Masuno
Naoshi Takeyama
Norio Yamashita
Hiroto Ikeda
Masashi Ueyama
Satoshi Fujimi
Satoshi Gando
on behalf of JAAM FORECAST group
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2186-7

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