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Mortality due to sepsis in Brazil in a real scenario: the Brazilian ICUs project

S. Lobo,E. Rezende,C. Mendes,M. C. de Oliveira

Published 2019 in Revista Brasileira de Terapia Intensiva

ABSTRACT

Worldwide, the number of sepsis patients per year is estimated at 15 to 17 million, contributing to more than 5 million deaths annually.(1-3) In Brazil, recent publications have indicated an increase in the number of cases of this syndrome in late years.(4) Many factors have contributed to this trend, such as population growth and rising in life expectancy, which rose from 65.3 years in 1990 to 71.5 years in 2013, increasing the susceptible population to include elderly people, people with chronic diseases, and immunosuppressed people.(5) In addition, initiatives such as the Sepsis Survival Campaign (CSS) and the Global Sepsis Alliance (GSA) are some means used in better identifying septic patients and increasing disease reporting. The Brazilian ICUs project, created by Epimed Solutions®, together with the Associação de Medicina Intensiva Brasileira (AMIB) (http://www.utisbrasileiras. com.br/project/), is based on the National Registry of Intensive Therapy, with the objective of characterizing the epidemiological profile of Brazilian intensive care units (ICUs) and sharing epidemiological information that may be useful in guiding public health policies and developing research and treatment strategies to improve the outcomes of critically ill patients in Brazil.(2,4) The participation of ICUs in the Epimed Database is voluntary and governed by a commercial agreement with Epimed Solutions®, an information technology company responsible for the development, updating, security, and backup of all processes.(4) The participants in the Brazilian ICUs project have access to a free and simplified version of the system. The purpose of this review was to disclose the temporal trends of sepsis prevalence and mortality. We evaluated data from a large national registry, with participation of approximately 30% of the adult ICU beds in the country, with data from 190,999 hospitalized patients between 2010 and 2016 in 638 ICUs from 349 public and private hospitals that were part of the Brazilian ICUs project. All of the Brazilian regions are represented, namely, 58.2% in the Southeast, 14.6% in the Northeast, 13.3% in the Midwest, 9.6% in the South, and 4.5% in the North. These data demonstrate a progressive increase in the number of cases of sepsis in Brazilian ICUs, from 19.4% of total hospitalizations in 2010 to 25.2% in 2016 (Figure 1), in addition to a stable and constant decrease in mortality. Mortality rates fell from 39% in 2010 to 30% in 2016 (absolute risk reduction ARR: 9.1%, 95%CI 7.7 -10.4%, p < 0.001) (Figure 2) in patients with sepsis, while they remained unchanged for other medical hospitalizations. Standardized Mortality Rates (SMR), i.e., corrected for disease severity by Suzana Margareth Lobo1, Ederlon Rezende2, Ciro Leite Mendes3, Mirella Cristinne de Oliveira4, on behalf of the participants of the Brazilian ICUs project

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