Epidemiology of Sepsis in Chinese Intensive Care Units: A National Cross-Sectional Survey

Background: Due to a scarcity of national epidemiologic data on sepsis, we performed a national cross-sectional survey to determine the epidemiologic characteristics of patients with sepsis in intensive care units (ICUs) in China. Methods: A national survey was performed in 44 hospitals which were selected by randomization according to the population from each province in mainland China. All septic patients in participating ICUs from December 1, 2015 to January 31, 2016 were included in the analysis. We recorded demographic, physiological and bacteriological data and followed up for 90 days or until death after inclusion. The incidence of and mortality due to sepsis in the ICU was calculated. The relationship between gross domestic product (GDP) and incidence of sepsis was also determined. Findings: Of 2,322 patients with sepsis included in the analysis, 786 (33.85%) patients had hospital-acquired sepsis with the most common infection site being the lung. The incidence of sepsis in the ICU was 20.6[95%CI 15.83-25.37] cases per 100 ICU admissions were diagnosed as sepsis. There was significant variation in the incidence of sepsis in the ICUs of different geographic regions. Ninety-day mortality due to sepsis was 35.49%, which yielded about 81,876 deaths in patients with ICU-treated sepsis every year in the mainland China. There was a significant relationship between the incidence of sepsis in the ICU and GDP per capita (R2=0.304, p=0.001) and the ratio of ICU beds to hospital beds (R2=0.270, p=0.003). Interpretation: Sepsis is a frequently occurring, life-threatening syndrome in the ICU with a high mortality in the mainland of China. Clinical Trial Number: This study was also registered in ClinicalTrials.gov (https://clinicaltrials.gov/show/NCT02448472). Funding Statement: This study was supported by a grant from the Development Center for Medical Science and Technology National Health and Family Planning Commission of the People’s Republic of China (WH2015-01-01), a grant from Jiangsu Provincial Key Medical Discipline (grant number: ZDXKA2016025) and a grant from Jiangsu Provincial Medical Talent (grant number: ZDRCA2016082). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The protocol of this study was approved by the ethics committees of Zhongda Hospital, School of Medicine, Southeast University (No. 2015ZDSYLL044.0), and every enrolled hospital. Patients admitted into the ICU were enrolled in this study following informed consent from the patient or their guardian.