Epidemiology and economic evaluation of severe sepsis in France: age, severity, infection site, and place of acquisition (community, hospital, or intensive care unit) as determinants of workload and cost

J Crit Care. 2005 Mar;20(1):46-58. doi: 10.1016/j.jcrc.2004.10.005.

Abstract

Purpose: Severe sepsis is a leading cause of death in critically ill patients. We evaluated cost and workload according to infection site, place and time of acquisition, and severity.

Material and method: We used a prospective 3-year database from 6 intensive care units (ICUs) including 1698 patients.

Results: Of the 1698 patients, 713 (42%) had severe sepsis at admission and 339 during the ICU stay (211 had both). Mortality was twice as high in patients with than those without ICU-acquired infection, independent of the presence of severe sepsis at admission. The mean (SD; median) cost of severe sepsis was 22 800 (21 400 ; 15 800 ). Among patients with severe sepsis at admission, workload and cost were higher for pneumonia, peritonitis, and multiple-site infections and for hospital-acquired (17,400 [14,700; 17,400]) vs community-acquired infection (12,600 [12,100 ; 8900 ]). Intensive care unit-acquired severe sepsis was associated with greater than 3-fold increases in workload and costs. By multiple linear regression, older age, emergency surgery, septic shock, Acute Physiological and Chronic Health Evaluation II score, and hospital or ICU-acquired severe sepsis were independently associated with higher costs.

Conclusions: The wide variations in cost and workload invite efforts to identify patient subgroups most likely to benefit from high-cost treatments and from prevention, particularly targeting severe nosocomial infections.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • APACHE
  • Age Distribution
  • Aged
  • Community-Acquired Infections / economics
  • Community-Acquired Infections / epidemiology
  • Cross Infection / economics
  • Cross Infection / epidemiology
  • Female
  • France / epidemiology
  • Health Care Costs*
  • Humans
  • Intensive Care Units*
  • Linear Models
  • Male
  • Middle Aged
  • Retrospective Studies
  • Systemic Inflammatory Response Syndrome / economics*
  • Systemic Inflammatory Response Syndrome / epidemiology*