Chest
Volume 138, Issue 2, August 2010, Pages 298-304
Journal home page for Chest

Original Research
Critical Care Medicine
Epidemiologic Trend of Severe Sepsis in Taiwan From 1997 Through 2006

https://doi.org/10.1378/chest.09-2205Get rights and content

Background

The epidemiologic data of severe sepsis are limited in developing countries. Among patients, the contribution of subsequent severe sepsis episodes to the disease burden is unclear.

Methods

We analyzed the hospitalization claims data of a nationally representative sample of 200,000 people, approximately 1% of the population, enrolled in the Taiwan National Health Insurance program. We identified first and subsequent episodes of severe sepsis hospital admissions from 1997 to 2006 based on International Classification of Diseases, 9th ed., Clinical Modification codes for infections and acute organ dysfunction.

Results

During the 10-year period, we identified 5,258 patients having 7,531 hospitalizations for severe sepsis in the study cohort. The age-standardized annual incidence rates of first episodes increased by 1.6-fold from 135 per 100,000 in 1997 to 217 per 100,000 in 2006, with an annual percent change of 3.9% (95% CI, 2.3%-5.5%). Although the proportion of patients with multiorgan (≥ 2) dysfunctions increased from 11.7% in 1997 to 27.6% in 2006, the hospital mortality changed little, averaging 30.8%. Among survivors, 34.4% developed at least one subsequent severe sepsis episode, which contributed 30.2% to the disease burden in 10 years.

Conclusions

The incidence and disease severity of severe sepsis in Taiwan are increasing. One-third of the survivors developed at least one subsequent episode, which contributed substantially to the disease burden over time.

Section snippets

Database

The National Health Insurance (NHI) system is compulsory and covers all citizens except prison inmates. Patients were drawn from the NHI Research Database (NHIRD),24 which was released for research purposes by the National Health Research Institutes, Taipei, Taiwan. The NHIRD covers nearly all (99%) inpatient and outpatient claims for its population of > 22 million, is one of the largest and most comprehensive databases in the world, and has been used extensively in various studies.25, 26, 27

Demographics and Clinical Characteristics

Of the 201,657 hospitalizations, including 18,092 ICU admissions, during the 10-year period, we identified 5,258 patients having 7,531 hospitalizations (average, 3.7 cases per 100 hospitalizations), including 3,560 ICU admissions (average, 19.7 cases per 100 ICU admissions) for severe sepsis. Of the 5,258 patients included in the study, 1,618 (30.8%) died during their first-episode admissions. Of the remaining 3,640 patients, 1,257 (34.4%) had one or more readmissions for subsequent episodes of

Discussion

In this study, we found significant transitions in the demographics of patients with severe sepsis and in their differential distribution of comorbidities, infection sites, and organ dysfunctions over time. These changes, also present in developed countries,4, 13 are influential for planning health services and resource allocations. More importantly, approximately one-third of the patients surviving their first episode of severe sepsis developed at least one subsequent episode, which will

Acknowledgments

Author contributions: Dr Shen: contributed to the study design, obtaining funding, data mining and processing, statistical analysis, drafting of the initial manuscript and revision for important content.

Ms Lu: contributed to the study design, data mining and processing, analysis and interpretation of results, and revision of the manuscript for important content.

Dr Yang: contributed to the chart reviews and revision of the manuscript for important content.

Other contributions: The study was based

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    Funding/Support: The study was performed in Chi Mei Medical Center and supported by grant CMFHR9753 from the hospital.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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