National Trends of Organ Dysfunctions in Sepsis: An 11-year Longitudinal Population-based Cohort Study

Background: Little is known about the trend of incidence and mortality of specific organ dysfunction among sepsis patients at the population level. This study aimed to examine the trend and mortality of organ dysfunction in patients with sepsis using a nationwide database in Taiwan.Methods: We conducted a study using 2002-2012 data from the nationwide health insurance database of Taiwan. Sepsis hospitalizations were identified by Angus algorithm to include all cases with ICD-9-CM codes for specific sepsis diagnosis and both an infectious process and a diagnosis of acute organ dysfunction. The primary outcome was the trend of incidence and in-hospital mortality of specific type of organ dysfunction in sepsis patients.Results: We identified 1,259,578 adult patients with sepsis. Acute respiratory' dysfunction, cardiovascular dysfunction/shock, and renal system dysfunction were the leading three types of acute organ dysfunction, accounting for 65.6, 30.5. and 18.3% of all sepsis patients, respectively. All types of organ dysfunction increased over time, except for hepatic and metabolic systems. Renal system (annual increase: 13.5%) and cardiovascular system dysfunction (annual increase: 4.3%) had the fastest increase. Mortality from all sources of infection has decreased significantly in the study period (trend p < 0.001).Conclusions: This is the first true nationwide population-based data showing the trend and outcome of acute organ dysfunction in sepsis patients. Renal and cardiovascular systems dysfunction are increasing at an alarming rate.