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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

2005; Elsevier BV; Volume: 20; Issue: 1 Linguagem: Inglês

10.1016/j.jcrc.2004.10.005

1557-8615

Christophe Adrie, Corinne Alberti, Carine Chaix-Couturier, Élie Azoulay, Arnaud de Lassence, Yves Cohen, Patrick Meshaka, Christine Cheval, Marie Thuong, Gilles Troché, Maïté Garrouste-Orgeas, Jean-François Timsit,

Healthcare Systems and Practices

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