The Surviving Sepsis Campaign has issued treatment guidelines for severe sepsis (Dellinger RP et al. 2004 Crit Care Med; 32:858-73). We examined the current use of several recommended and not recommended interventions in severe sepsis patients currently captured across the 5 highest enrolling countries in PROGRESS, the international web-based severe sepsis registry.
PROGRESS is a prospective, observational registry. Participating ICUs enroll patients who have severe sepsis (suspected or proven infection and >=1 acute sepsis-induced organ dysfunction). All data handling is by secure website and all patient data are de-identified. An independent advisory committee with professional society representation governs PROGRESS, including oversight of data quality, access, and analysis. The software development and website maintenance was funded by Eli Lilly.
As of April 1, 2004, PROGRESS has enrolled 4387 severe sepsis patients in 32 countries. Disease severity by APACHE II score, hospital mortality, and severe sepsis interventions used across the 5 highest enrolling countries to date are presented in the tableGermany n=743Argentina n=514Australia n=463India n=446Brazil n=344APACHE II (mean ± SD)21.2±7.3 n=48926.8±8.4 n=45620.1±7.3 n=46119.6±7.6 n=22121.9±7.7 n=314Hospital mortality (%)45.954.432.442.368.4Mechanical ventilation (%)90.073.790.160.889.2Vasopressors (%)92.367.589.260.378.2Fluid resuscitation (%)93.988.587.963.093.0Albumin (NE) (%)5.09.555.336.19.3Low dose steroids (%)42.921.426.623.152.9Renal replacement therapy (%)36.3220.127.116.111.2Drotrecogin alfa (activated) (%)18.104.22.168.66.4ATIII therapy (NR) (%)10.10.216.0-0.9Nitric oxide therapy (NE) (%)2.00.210.4--IV gamma globulin (NE) (%)0.50.42.60.21.7. NE= not evaluated in guidelines; NR= not recommended in guidelines.
As shown above, disease severity (by APACHE II), hospital mortality, and the current use of recommended treatments for severe sepsis differ markedly across the highest enrolling countries of PROGRESS. Analyses adjusting for case-mix are required to better understand the relationship between the use of recommended sepsis interventions and mortality.
PROGRESS may provide a consistent tool for ICUs to track implementation of treatment guidelines and outcome for severe sepsis in their units.
K. Reinhart, I have served as a consultant to Eli Lilly.