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Current Epidemiology of Septic Shock

The CUB-Réa Network

Service de Réanimation Médicale, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches; Service de Biostatistique et Informatique Médicale, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris, Boulogne; Service de Réanimation Médicale, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris, Paris; and INSERM U444, Paris, France

Correspondence and requests for reprints should be addressed to Djillali Annane, M.D., Ph.D., Service de Réanimation Médicale, Hôpital Raymond Poincaré, Faculté de Médecine Paris Ile de France Ouest, Université de Versaille Saint Quentinen-Yvelinnes, 104, Boulevard Raymond Poincaré, 92380 Garches, France. E-mail: djillali.annane{at}rpc.ap-hop-paris.fr

To update the epidemiology of septic shock we analyzed clinical, microbiologic, and outcome variables from 100,554 intensive care unit admissions on the Collège des Utilisateurs de Bases de données en Réanimation (CUB-Réa) database, collected from 22 hospitals over a 8-year period, 1993 to 2000. The overall frequency of septic shock was 8.2 per 100 admissions (i.e., 8,251 stays). It increased from 7.0 (in 1993) to 9.7 per 100 admissions (in 2000). The distribution analysis of the sites of infection and of the types of pathogens showed an increase in the rate of pulmonary infection (p = 0.001) and of multiresistant bacteria-related septic shock (p = 0.001). The crude mortality was 60.1% and declined from 62.1% (in 1993) to 55.9 (in 2000) (p = 0.001). As compared with matched intensive care unit admissions without sepsis, the excess risk of death due to septic shock was 25.7 (95% confidence interval, 24.0–27.3) and the matched odds ratio of death was 3.9 (95% confidence interval, 3.5–4.3). The frequency of septic shock is increasing with more multiresistant strains. Its crude mortality rate is decreasing, but patients with septic shock still have a high excess risk of death than critically ill patients who are nonseptic.

Key Words: sepsis • epidemiologic studies • case–control studies • intensive care unit • outcome

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