THE ITALIAN SEPSIS STUDY - PRELIMINARY-RESULTS ON THE INCIDENCE AND EVOLUTION OF SIRS, SEPSIS, SEVERE SEPSIS AND SEPTIC SHOCK

This prospective, multicenter, epidemiological study was carried out i n 99 Italian ICUs, distributed throughout the country, from April 1993 to March 1994. In the study, we applied the new ACCP/SCCM classificat ion system for sepsis (SIRS, sepsis, severe sepsis and septic shock) a nd determined the prevalence, incidence, evolution and outcome of thes e categories in critically ill patients. The preliminary analysis of 1 101 patients showed that on admission SIRS accounted for about half of the diagnoses (52%) with sepsis, severe sepsis and septic shock accou nting for 4.5%, 2.1% and 3% of patients, respectively. Patients with s evere sepsis or septic shock more frequently had high SAPS scores than patients without sepsis. Mortality rates were similar in patients wit h SIRS (26.5%) and without SIRS or infection (24%), but rose to 36% in patients with sepsis, to 52% in those with severe sepsis and to 81.8% in those with septic shock. Sepsis, severe sepsis and septic shock we re more common in patients with medical diagnoses, and neither severe sepsis nor septic shock was observed in trauma patients. With respect to evolution, the incidence of septic shock was progressively higher i n patients admitted with more severe ''sepsis-related'' diagnoses, whi le only a trivial difference in rates of incidence was observed betwee n SIPS patients and those admitted without SIPS or any septic disorder (nil). The breakdown of the various ACCP/SCCM ''sepsis-related'' diag noses at any time during the study was: SIRS in 58% of the population, sepsis in 16.3%, severe sepsis in 5.5% and septic shock in 6.1%. It s eems reasonable to expect from the final evaluation of our study answe rs to the questions raised by the ACCP/SCCM Consensus Conference about the correlations between ''sepsis-related'' diagnosis, severity score , organ dysfunction score and outcome.