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Cited by 8,503Sepsis Diagnosis and TreatmentNosocomial Infections in ICUHealth Systems, Economic Evaluations, Quality of Life

Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care

Angus, Derek C., Linde-Zwirble, Walter T., Lidicker, Jeffrey, Clermont, Gilles, Carcillo, Joseph, Pinsky, Michael R.·2001·Critical Care Medicine
DOI 10.1097/00003246-200107000-00002
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Abstract

OBJECTIVE: To determine the incidence, cost, and outcome of severe sepsis in the United States. DESIGN: Observational cohort study. SETTING: All nonfederal hospitals (n = 847) in seven U.S. states. PATIENTS: All patients (n = 192,980) meeting criteria for severe sepsis based on the International Classification of Diseases, Ninth Revision, Clinical Modification. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We linked all 1995 state hospital discharge records (n = 6,621,559) from seven large states with population and hospital data from the U.S. Census, the Centers for Disease Control, the Health Care Financing Administration, and the American Hospital Association. We defined severe sepsis as documented infection and acute organ dysfunction using criteria based on the International Classification of Diseases, Ninth Revision, Clinical Modification. We validated these criteria against prospective clinical and physiologic criteria in a subset of five hospitals. We generated national age- and gender-adjusted estimates of incidence, cost, and outcome. We identified 192,980 cases, yielding national estimates of 751,000 cases (3.0 cases per 1,000 population and 2.26 cases per 100 hospital discharges), of whom 383,000 (51.1%) received intensive care and an additional 130,000 (17.3%) were ventilated in an intermediate care unit or cared for in a coronary care unit. Incidence increased >100-fold with age (0.2/1,000 in children to 26.2/1,000 in those >85 yrs old). Mortality was 28.6%, or 215,000 deaths nationally, and also increased with age, from 10% in children to 38.4% in those >85 yrs old. Women had lower age-specific incidence and mortality, but the difference in mortality was explained by differences in underlying disease and the site of infection. The average costs per case were $22,100, with annual total costs of $16.7 billion nationally. Costs were higher in infants, nonsurvivors, intensive care unit patients, surgical patients, and patients with more organ failure. The incidence was projected to increase by 1.5% per annum. CONCLUSIONS: Severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction. It is especially common in the elderly and is likely to increase substantially as the U.S. population ages.

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Authors
Angus, D. C., Linde-Zwirble, W. T., Lidicker, J., Clermont, G., Carcillo, J., & Pinsky, M. R.
Affiliations
University of Pittsburgh (US)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2001-07
Volume
29
Issue
7
Pages
1303-1310
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/00003246-200107000-00002
OpenAlex
W2049927822
Cited by
8,503
References
2
Citations by year
2026: 94 · 2025: 154 · 2024: 250 · 2023: 276 · 2022: 288 · 2021: 356 · 2020: 371 · 2019: 368 · 2018: 433 · 2017: 434 · 2016: 465 · 2015: 526 · 2014: 547 · 2013: 518 · 2012: 466
FWCI
135.59
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • D-Scholarship@Pitt (University of Pittsburgh) (acceptedVersion)
Funders
  • Microsoft
  • Centers for Disease Control and Prevention
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
incidence, mortality, health care costs, intensive care utilization, mechanical ventilation, age differences, sex differences, organ dysfunction, hospital discharge data, sepsis epidemiology, United States, hospital costs, sepsis mortality, sepsis incidence
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Intensive Care Units, Length of Stay, Male, Middle Aged, United States, Cohort Studies, Incidence, Multivariate Analysis, Treatment Outcome, Health Care Costs, Hospital Mortality, Age Distribution, Sepsis

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