Trends in mortality in septic patients according to the different organ failure during 13 years

Abstract Background: the incidence of sepsis can be estimated between 250 and 500 cases/100.000 people per year and is responsible for up to 6% of total hospital admissions. Identified as one of the most relevant global health problems, sepsis is the condition that generates the highest costs in the healthcare system. Important changes in the management of septic patients have been included in recent years, however, there is no information about how changes in the management of sepsis-associated organ failure have contributed to mortality.Methods: A retrospective analysis was conducted from hospital discharge records from the Minimum Basic Data Set Acute-Care Hospitals (CMBD-HA in Catalan language) for the Catalan Health System (CatSalut). CMBD-HA is a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia. Sepsis was defined by the presence of infection and at least one organ dysfunction. Patients hospitalized with sepsis were detected, according ICD-9-CM codes used to identify acute organ dysfunction and infectious processes.Results: Of 9.875.635 discharges from all acute-care hospitals during the study period (2005-2017), 254.627 had sepsis (2,58%). The mean annual sepsis incidence in the population was 245,5 per 100.000 inhabitants/year. Multiorgan failure was present in 20,3% and bacteremia in 29,1% of cases. Renal was the most frequent organ failure (55,9%), followed by cardiovascular (23,9%). Hospital mortality during the study period was 20,8%, but decreases continuously from 25,7% in 2005 to 16,5% in 2017 (p<0,0001) whereas rates of multiorgan failure and bacteraemia remains unchanged. The most important reduction in mortality was observed in cases with cardiovascular failure (from 47,3% in 2005 to 29,9% in 2017) (p<0,0001). In the same way, mean mortality related to respiratory and renal failure in sepsis was decreased in last years (p<0,0001). Conclusions: The incidence of sepsis has been increasing in recent years in our country. However, hospital mortality has been significantly reduced. In septic patients, all organ failures except liver have shown a statistically significant reduction on associated mortality, with cardiovascular failure as the most relevant.