Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study

Byline: Sari Karlsson (1,2), Marjut Varpula (3), Esko Ruokonen (4), Ville Pettila (5), Ilkka Parviainen (4), Tero I. Ala-Kokko (6), Elina Kolho (7), Esa M. Rintala (8) Keywords: Severe sepsis; Septic shock; Incidence; Mortality; Treatment protocols Abstract: Objective To determine the incidence and outcome of severe sepsis in the adult Finnish population and to evaluate how treatment guidelines in severe sepsis are applied in clinical practice. Study design A prospective study in 24 closed multidisciplinary ICUs in 21 hospitals (4 university and 17 tertiary hospitals) in Finland. Patients All 4,500 consecutive ICU admission episodes were screened for severe sepsis during a 4-month period (1 November 2004 -- 28 February 2005). The referral population was 3,743,225. Results The severe sepsis criteria were fulfilled in 470 patients, who had472 septic episodes. The incidence of severe sepsis in the ICUs in Finland was 0.38/1000 in the adult population (95% confidence interval 0.34--0.41). The mean ICU length of stay was 8.2a-+-a-8.1a-days. ICU, hospital, and 1-year mortality rates were 15.5%, 28.3%, and 40.9%, respectively. Respiratory failure requiring ventilation support was the most common organ failure (86.2%) septic shock was present in 77% and acute renal failure in 20.6% of cases. Activated protein C was given to only 15 of the 55 patients with indication (27%) and low-dose corticosteroids to 150 of 366 (41%) patients with septic shock. Conclusions This prospective study found the incidence of ICU-treated severe sepsis in Finland to be 0.38 per 1,000 of the population. The ICU and hospital mortalities were also lower than earlier reported in United States or Australia. Evidence-based sepsis therapies were not used as often as recommended. Author Affiliation: (1) Aurinkokatu 3B38, 13100, Hameenlinna, Finland (2) Division of Intensive Care, Tampere University Hospital, Tampere, Finland (3) Division of Intensive Care, Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland (4) Division of Intensive Care, Kuopio University Hospital, Kuopio, Finland (5) Division of Intensive Care, Department of Surgery, Helsinki University Hospital, Helsinki, Finland (6) Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland (7) Division of Infectious Diseases, Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland (8) Division of Infectious Diseases, Department of Internal Medicine, Satakunta Central Hospital, Satakunta, Finland Article History: Registration Date: 04/12/2006 Received Date: 29/06/2006 Accepted Date: 01/12/2006 Online Date: 16/01/2007 Article note: For the Finnsepsis Study Group. This research was supported by a grant from the Paivikki and Sakari Sohlberg Foundation ( www.pss-saatio.fi), EVO grant TYH 6235 from Helsinki University Hospital, a grant from the Finnish Intensive Care Association ( www.sthy.fi), and a grant from the Finnish Medical Association ( www.laakariliitto.fi).