Intensive Care Medicine

, Volume 31, Issue 2, pp 213–219 | Cite as

One-year mortality of bloodstream infection-associated sepsis and septic shock among patients presenting to a regional critical care system

  • Kevin B. LauplandEmail author
  • David A. Zygun
  • Christopher J. Doig
  • Sean M. Bagshaw
  • Lawrence W. Svenson
  • Gordon H. Fick



The long-term mortality outcome associated with sepsis and septic shock has not been well defined in a nonselected critically ill population. This study investigated the occurrence and the role of bloodstream infection (BSI) associated sepsis and septic shock at time of intensive care unit (ICU) admission on the 1-year mortality of patients admitted to a regional critical care system.

Design and setting

Population-based inception cohort in all adult multidisciplinary and cardiovascular ICUs in the Calgary Health Region (population approx. 1 million) between 1 July 1999 and 31 March 2002.

Patients and participants

Adults (≥18 years; n=4,845) who had at least one ICU admission to CHR ICUs.


In 251 (5%) patients there was BSI-associated sepsis at presentation to ICU, and 159 of these also had septic shock. The 28-day, 90-day, and 1-year mortality rates overall were 18%, 21%, and 24%: 23%, 30%, and 36% for BSI-associated sepsis without shock, and 51%, 57%, and 61% with shock, respectively. Surgical diagnosis, BSI-associated sepsis, and increasing age were independently associated with late (28-day to 1-year) mortality whereas higher APACHE II and TISS scores were associated with reduced odds in logistic regression analysis.


BSI-associated sepsis and septic shock are associated with increased risk of mortality persisting after 28-days up to 1 year or more. Follow-up duration beyond 28 days better defines the burden of illness associated with these syndromes.


Bloodstream infection Bacteremia Intensive care unit Population-based Risk factor Mortality 

Supplementary material

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  1. 1.
    Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J (2004) Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med 30:589–596Google Scholar
  2. 2.
    Pittet D, Rangel-Frausto S, Li N, Tarara D, Costigan M, Rempe L, Jebson P, Wenzel RP (1995) Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med 21:302–309Google Scholar
  3. 3.
    Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, Parsonnet J, Panzer R, Orav EJ, Snydman DR (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group. JAMA 278:234–240CrossRefGoogle Scholar
  4. 4.
    Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K (2003) Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med 31:2332–2338CrossRefPubMedGoogle Scholar
  5. 5.
    EPISEPSIS Study Group (2004) EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med 30:580–588CrossRefGoogle Scholar
  6. 6.
    Alberti C, Brun-Buisson C, Goodman SV, Guidici D, Granton J, Moreno R, Smithies M, Thomas O, Artigas A, Le Gall JR (2003) Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients. Am J Respir Crit Care Med 168:77–84CrossRefGoogle Scholar
  7. 7.
    Sasse KC, Nauenberg E, Long A, Anton B, Tucker HJ, Hu TW (1995) Long-term survival after intensive care unit admission with sepsis. Crit Care Med 23:1040–1047CrossRefPubMedGoogle Scholar
  8. 8.
    Hugonnet S, Harbarth S, Ferriere K, Ricou B, Suter P, Pittet D (2003) Bacteremic sepsis in intensive care: temporal trends in incidence, organ dysfunction, and prognosis. Crit Care Med 31:390–394CrossRefGoogle Scholar
  9. 9.
    Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Regnier B (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 274:968–974PubMedGoogle Scholar
  10. 10.
    Pittet D, Thievent B, Wenzel RP, Li N, Auckenthaler R, Suter P (1996) Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients. Am J Respir Crit Care Med 153:684–693Google Scholar
  11. 11.
    Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554CrossRefPubMedGoogle Scholar
  12. 12.
    Moss M, Martin GS (2004) A global perspective on the epidemiology of sepsis. Intensive Care Med 30:527–529Google Scholar
  13. 13.
    Brun-Buisson C (2000) The epidemiology of the systemic inflammatory response. Intensive Care Med 26 [Suppl 1]:S64–S74Google Scholar
  14. 14.
    Quartin AA, Schein RM, Kett DH, Peduzzi PN (1997) Magnitude and duration of the effect of sepsis on survival. Department of Veterans Affairs Systemic Sepsis Cooperative Studies Group. JAMA 277:1058–1063PubMedGoogle Scholar
  15. 15.
    Perl TM, Dvorak L, Hwang T, Wenzel RP (1995) Long-term survival and function after suspected gram-negative sepsis. JAMA 274:338–345PubMedGoogle Scholar
  16. 16.
    Doig CJ, Zygun DA, Fick GH, Laupland KB, Boiteau PJ, Shahpori R, Rosenal T, Sandham JD (2004) Study of clinical course of organ dysfunction in intensive care. Crit Care Med 32:384–390CrossRefGoogle Scholar
  17. 17.
    Church D, Hall P (1999) Centralization of a regional clinical microbiology service: the Calgary experience. Can J Infect Dis 10:393–402Google Scholar
  18. 18.
    Laupland KB, Davies HD, Church DL, Louie TJ, Dool JS, Zygun DA, Doig CJ (2004) Bloodstream infection-associated sepsis and septic shock in critically ill adults: a population-based study. Infection 32:59–64CrossRefGoogle Scholar
  19. 19.
    Laupland KB, Zygun DA, Davies HD, Church DL, Louie TJ, Doig CJ (2002) Population-based assessment of intensive care unit-acquired bloodstream infections in adults: incidence, risk factors, and associated mortality rate. Crit Care Med 30:2462–2467CrossRefGoogle Scholar
  20. 20.
    Knaus W, Draper E, Wagner D, Zimmerman J (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedGoogle Scholar
  21. 21.
    Cullen D, Civetta J, Briggs B, Ferrara L (1974) Therapeutic interventions scoring system: a method of quantitative comparison of patient care. Crit Care Med 2:57–60PubMedGoogle Scholar
  22. 22.
    Brun-Buisson C, Doyon F, Carlet J, French Bacteremia-Sepsis Study Group (1996) Bacteremia and severe sepsis in adults: a multicenter prospective survey in ICUs and wards of 24 hospitals. Am J Respir Crit Care Med 154:617–624PubMedGoogle Scholar
  23. 23.
    Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310CrossRefPubMedGoogle Scholar
  24. 24.
    Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273:117–123CrossRefPubMedGoogle Scholar
  25. 25.
    Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, Sicignano A, Palazzo M, Moreno R, Boulme R, Lepage E, Le Gall R (2002) Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 28:108–121PubMedGoogle Scholar
  26. 26.
    Friedman G, Silva E, Vincent JL (1998) Has the mortality of septic shock changed with time. Crit Care Med 26:2078–2086PubMedGoogle Scholar
  27. 27.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31:1250–1256CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Kevin B. Laupland
    • 1
    • 2
    • 3
    • 4
    Email author
  • David A. Zygun
    • 1
    • 4
  • Christopher J. Doig
    • 1
    • 2
    • 4
  • Sean M. Bagshaw
    • 1
    • 4
  • Lawrence W. Svenson
    • 4
    • 5
  • Gordon H. Fick
    • 4
  1. 1.Department of Critical Care MedicineUniversity of CalgaryCalgaryCanada
  2. 2.Department of MedicineUniversity of CalgaryCalgaryCanada
  3. 3.Department of Pathology and Laboratory MedicineCalgary Laboratory Services and University of CalgaryCalgaryCanada
  4. 4.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  5. 5. Health Surveillance BranchAlberta Health and WellnessEdmontonCanada

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