The document summarizes a study on severe sepsis and septic shock patients admitted to a medical ICU in Turkey between 2007-2014. The key findings are: 1) 33.1% of ICU patients were admitted with severe sepsis or septic shock, with an overall mortality rate of 48.3%. 2) The most common infection source was respiratory (45.5%) and the most frequent isolated organism was E. coli (23%). 3) While the frequency of sepsis varied over the 8-year period, mortality rates in the ICU and hospital did not significantly change over time.

1. Kazım Rollas, Pervin Hancı, Kezban Ozmen Süner, Nesrin Damla Eyüpoglu,
Ozgür Kılıç, Burçin Halaclı, Mehmet Nezir Güllü, Nazmiye Ebru Ersoy Ortac,
Serpil Göcmen, Arzu Topeli
Medical Intensive Care Unit, Faculty of Medicine, Hacettepe
University, Ankara, Turkey

2. INTRODUCTION
 Even in the developed countries, the frequency of
sepsis is increasing.
 Sepsis is the most common cause of death in non-
coronary intensive care units (*).
 There is not enough data available concerning the
epidemiology of sepsis in our country.
* Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in
the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29:1303-10

3. OBJECTIVE
 We aimed to investigate the frequency and general
characteristics of the severe sepsis and septic shock
patients in our unit.

4. METHOD
 The records of all patients admitted to the medical ICU of
Hacettepe university hospital between 1st January 2007 and
31st December 2014 were retrospectively reviewed from
unit’s database and hospital electronic records. Severe
sepsis and septic shock patients were included
 Data are presented as number of cases (%) and median
(minimum–maximum).

5. RESULTS
 Over the 8 year period, 1507 patients were admitted to
ICU.
 Of those,104 patients who had less than 24 hours of
hospitalization were excluded.
 464 (33.1%) of 1403 patients were admitted to ICU with
severe sepsis and septic shock.
 224 (48.3 %) patients died in the ICU.
 269 (58 %) patients died during the hospital stay.
 Mean expected mortality rate adjusted for APACHE II
score was 48.1%.

6. Total
n=464
Nonsurvivor
n=224
Survivor
n=240
P value
Age 64 (17-95) 64 (18-92) 65 (17-95) 0.55
Sex (male/female) 258/206 (55.6) 131/93 (58.5) 127/113 ( 52.9) 0.26
APACHE II 23 (5-59) 27 (7-59) 20 (5-52) <0.01
SOFA 9 (2-20) 11 (3-20) 8 (2-20) <0.01
Number of organ failure 3 (1-6) 3 (1-6) 3 (1-6) <0.01
Lactate (mmol/L) 2.1 (0.2-16) 2.4 (0.3-14.3) 1.7 (0.2-16) <0.01
Charlson comorbidity index 4 (0-15) 4 (0-15) 3.5 (0-13) 0.02
Comorbidities
Cardiac diseases 182 (39.2) 89 (39.7) 93 (38.7) 0.91
Diabetes mellitus 103 (22.2) 42 (18.8) 61 (25.4) 0.09
Chronic respiratory failure 98 (21.1) 40 (17.9) 58 (24.2) 0.11
Solid cancers 93 (20.0) 51(222.8) 42(17.5) 0.16
Chronic renal failure 85 (18.3) 43 (19.2) 42 (17.5) 0.71
Hematologic cancers 45 (9.7) 31 (13.8) 14 (5.8) <0.01
Neurological diseases 43 (9.3) 20 (8.9) 23 (9.6) 0.87
Hematological diseases 20 (4.3) 12 (5.4) 8 (3.3) 0.36
Rheumatological diseases 17 (3.4) 4 (1.8) 13 (5) 0.07
Chronic liver failure 15 (3.2) 10 (4.5) 5 (2.1) 0.19
Length of stay in ICU (day) 8 (2-189) 8 (2-182) 9 (2-189) 0.03
Length of stay in hospital (day) 23 (2-189) 17.5 (2-182) 29 (3-89) 0.01

7. Total
n=464
Nonsurvivor
n=224
Survivor
n=240
P value
Procalcitonin (mg/L) 3.1 (0.02-468) 4.05(0.04-468) 2.17 (0.02-351) <0.01
C-reaktive protein
(mg/L)
12.6 (0.08-69.1) 13.4 (0.13-69.1) 12.1 (0.08-69) 0.24
Vasopressors 294/456 (64.5) 172/222 (77.5) 122 /234 (52.1) <0.01
Inotropes 80/391 ( 20.5) 50/187 (26.7) 30/204 (14.7) <0.01
Steroids 271/453 (36.8) 150/221 (67.9) 121/232(52.2) <0.01
Red blood cell
transfusion
225/456 (49.3) 131/220 (59.5) 94/236 ( 39.8) <0.01
Invasive mechanical
ventilation
291/460 (63.3) 162/222 (73) 129/238(54.2) <0.01
Noninvasive mechanical
ventilation
118/460 (25.4) 64/222 (28.8) 54/ 238 (22.7) 0.13
Hemodialysis 156/458(34.1) 87/222 ( 39.2) 69/236(29.2) 0.03

8. Suspected Sepsis/Infection Source
Total
n=464
Nonsurvivor
n=224
Survivor
n=240
P value
Respiratory 211 (45.5) 100 (4.6) 111 (46.3) 0.78
Urinary 40 (8.6) 13 (5.8) 27 (11.3) 0.04
Blood stream 37 (8.0) 22 (9.8) 15 (6.3) 0.17
Intraabdominal 22 (5.0) 10 (4.5) 12 (5.0) 0.83
Skin- soft tissue 20 (4.3) 9 (4.0) 11 (4.6) 0.82
Unknown source 134 ( 28.9) 70 (26.7) 64 (31.3) 0.30

9. 50,6 % of patients had positive microbial isolates
Site of
infection
Total
n=464
Nonsurvivor
n=224
Survivor
n=240
P value
Respiratory 89 (37.9) 55 (45.1) 34 (30.1) 0.02
Bloodstream 75 (31.9) 38 (31.1) 37 (32.7) 0.88
Urinary tract 51 (21.7) 20 (16.4) 31 (27.4) 0.05
Wound /soft
tissue
11 (4.7) 5 (4.1) 6(5,3) 0.76
Others 9 (3.8) 4 (3.3) 5 (4.4) 0.74

10. Isolated microorganisms
Total
n=235 (%)
Nonsurvivor
n=122 (%)
Survivor
n=113 (%)
P value
Escherichia coli spp. 54 (23) 22 (18) 32 (28.3) 0.06
Candida spp. 38 (16.2) 23 (18.9) 15 (13.3) 0.28
Acinetobacter spp. 37 (15.7) 18 (14) 19(16.8) 0.72
Enterococcus spp. 22(9.4) 20 (16.4) 9 (8) 0.07
Staphylococcus aureus 23 (8.9) 11 (9.0) 12 (10.6) 0.82
Pseudomonas spp. 19 (8.1) 11 (9.0) 8 (7.1) 0.63
Klebsiella spp. 19 (8.1) 13 (10.7) 6 (5.3) 0.15
Staphylococcus epidermidis 7 ( 3.0) 2 (1.6) 5 (4.4) 0.26
Staphylococcus
haemalyticus
7 (3) 4 (4.3) 3 (2.7)
Streptococcus pneumoniae 5 (2.1) 3 (2.5) 2 (1.8)
Stenotrophomonas
maltophilia
5 (2.1) 4 (3.3) 1 (0.9) 0.37
Aspergillus spp. 4 (1.7) 3 (2.5) 1 (0.9) 0.62
Others 33(14.0) 18 (14.8) 15 (13.3) 0.85
Polimicrobial 42 (17.9) 25 (20.5) 17 (15) 0.3

11. The frequency and mortality rates of severe sepsis and
septic shock patients over the years
33,5
37,5
21,3
37,9 38,5
36,3 35,7
24,5
55,5
43,4
37,8
53,4
48,3
46,7
50,8 51
58,4
52,1 51,3
63,1
57,6
59,6 60,6
65,3
0
10
20
30
40
50
60
70
2007
APACHE II
26 (11-48)
2008
APACHE II
28 (10-52)
2009
APACHE II
26 (9-59)
2010
APACHE II
26(10-46)
2011
APACHE II
18 (7-34)
2012
APACHE II
20 (5-44)
2013
APACHE II
19 (8-43)
2014
APACHE II
24 (10-43)
The frequency of severe sepsis and
septic shock
Mortality in ICU
Mortality in hospital
The frequency is lower in 2009 and 2014 ( respectively p <0.01 and p<0,01)
p = 0.87 for ICU mortality over the years
p= 0.14 for hospital mortality over the years

12. DISCUSSION
 Frequency of severe sepsis/ septic shock was 33 % in
our unit’s large patient sample.
 Frequency of severe sepsis was detected as 30% for
European Intensive Care Units by Vincent et al (SOAP
trial).
Vincent JL, Sakr Y, Sprung CL, Reinhart MR, et al. Sepsis in European Intensive Care Units: Result of the
SOAP Study. Crit Care Med, 2006; 34: 344-353

13.  Mortality of patients with severe sepsis and septic
shock was found as 48.3 % in our intensive care unit.
 In SOAP trial, mortality of severe sepsis and septic
shock was 32% and 54 % respectively

14.  The most common cause of sepsis was respiratory tract
(37.9 %), and the most frequent isolated agents were
gram negative microorganisms.
 The most common cause of sepsis was found as
respiratory tract (40 %), and the most common agent
was found as gram negative bacterias by Mayr et al.
Mayr FB, Yende S, Linde-Zwirble WT, Peck-Palmer OM, Barnato AE, Weissfeld LA, Angus DC.
Infection rate and acute organ dysfunction risk as explanations for racial differences in severe
sepsis. JAMA. 2010;303:2495–503.

15.  In our unit, there was differences in the frequency of sepsis
over the 8 years but significant change was not observed in
ICU and hospital mortality.

16. CONCLUSION
 Severe sepsis/ septic shock remains a common disease
with high mortality in ICU.
 In our counrty, there is a need for prospective multi-
center studies about sepsis epidemiology.