Declining mortality due to severe sepsis and septic shock in Spanish intensive care units: A two-cohort study in 2005 and 2011

Abstract Objective To analyze the evolution of sepsis-related mortality in Spanish Intensive Care Units (ICUs) following introduction of the Surviving Sepsis Campaign (SSC) guidelines and the relationship with sepsis process-of-care. Design A prospective cohort study was carried out, with the inclusion of all consecutive patients presenting severe sepsis or septic shock admitted to 41 Spanish ICUs during two time periods: 2005 (Edusepsis study pre-intervention group) and 2011 (ABISS-Edusepsis study pre-intervention group). Scope Patients with severe sepsis or septic shock admitted to Spanish ICUs. Patients All ICU admissions from the emergency department or wards and all ICU patients with a diagnosis of severe sepsis or septic shock. A total of 1348 patients were included: 630 in the 2005 group and 718 in the 2011 group. Intervention None. Primary endpoints ICU mortality, 28-day mortality and Hospital mortality, hospital length of stay, ICU length of stay and compliance with the resuscitation bundle. Results Compliance with the resuscitation bundle was significantly greater in the 2011 group (5.7% vs. 9.9%; p  = 0.005), and was associated to lower mortality (OR 0.602 [0.365–0.994]; p  = 0.048). The 2011 group had lower absolute in-hospital mortality (44.0% vs. 32.6%; p  = 0.01), 28-day mortality (36.5% vs. 23.0%; p  = 0.01), and adjusted mortality (OR 0.64 [0.49–0.83], p  = 0.001). Conclusions Mortality related to severe sepsis or septic shock in Spain decreased between two patient cohorts in 2005 and 2011, and was attributable to earliness and improvement in sepsis care.