sepsis kills you can count on itsepsis kills –you can count on it paul huggan this is a talk about...
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Sepsis Kills – You
Can Count On It
Paul Huggan
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This is a talk about sepsis epidemiology….
• Are 1% of the adult population in New Zealand
admitted to hospital with sepsis each year?
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Data doesn’t define people
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Background
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INFECTION
ORGAN
FAILUREICU
SEPSIS
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“Our study provides evidence that
sepsis-related mortality has
steadily decreased over time even
after adjustments for illness
severity, center effect, regional
effects, hospital size, risk
of being septic, and other key
variables.”
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Clinical vs ANZICS CORE Definition
Clinical ANZICS CORE P- value
ICU Prevalence 16.9% 11% <0.001
Septic shock 5.7% 9.6% <0.001
In-hospital death 27% 17% 0.12
In-hospital death
(shock)
37% 16% 0.006
“Database criteria significantly underestimate incidence of sepsis and
overestimate incidence of septic shock, resulting in lower estimated hospital
mortality rates for each condition”
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INFECTION
In
Hospital
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Infectious disease hospitalisation in New Zealand
▪ Infections are the most common cause of
hospitalisation in NZ
▪ Twice the rate of admission amongst Maaori and
Pacific people compared with European/other
▪ Almost 3 times rate of admission amongst most
deprived (NZDep 9-10) compared with the least
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INFECTION
ORGAN
FAILUREHospital
SEPSIS
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A: Infection (n=48) B: Organ Failure (n=69)
+
Defining Sepsis using ICD-10-AM
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Waikato DHB Sepsis
Per 100,000 population
• Total
• 500
• Over 65
• 2500
• Admitted to ICU
• 17%
• Mortality
• 18% in hospital
• 37% at one year
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“Isn’t coding rubbish?”
• New codes and coding strategies (Gohil et al)
– Introduction of dedicated “sepsis” code (2002)
– Introduction of DRG system (2007)
• Laboratory paradox
– Increasing incidence of ICD9 sepsis, falling
bacteremia and lactatemia rates (Rhee et al)
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Objective evaluation vs medical records
Sn - ≥ 5.6%
Sp - ≥ 78%
Sn* - ≥ 42.6%
Sp* - ≥ 86%
* Angus et al Crit Care Med 2001
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Novel methods to estimate incidence
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Other insights
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Sepsis Admissions, Waikato DHB
With thanks to Sheena Moosa
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Impact of QI initiative – “Sepsis Ready”
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Thank you
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Sepsis: A National Approach
Sepsis.org.nz