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Sepsis in the Intensive Care Unit: Etiologies,
Prognostic Factors and Mortality*
Sepse na Unidade de Terapia Intensiva: Etiologias,
Fatores Prognósticos e Mortalidade
Fernando Zanon1; Jairo José Caovilla2; Regina Schwerz Michel3; Estevan Vieira Cabeda3;
Diego Francisco Ceretta3; Graziela Denardin Luckemeyer4; Cássia Beltrame4; Naiana Posenatto4

SUMMARY developed SIRS (58%). The most frequent cause of in-
ternation was neurological disease (28.9%), the most fre-
BACKGROUND AND OBJECTIVES: Sepsis is the main quent site of infection was the respiratory tract (71.6%),
cause of death in patients treated in intensive care units and the most prevalent pathogens were gram-negative
(ICU). The aim of this study was to evaluate etiology, bacilli (53.2%). Mean APACHE II score was 18 ± 9, and
prognostic factors and mortality of septic patients treated mean SOFA score was 5 ± 4. Median ICU stay was 6
in ICU of Passo Fundo, Brazil. (3-11) days and overall mortality rate was 31.1%: 6.1%
METHODS: Out of 971 consecutive patients prospecti- for non-infectious SIRS, 10.1% for sepsis, 22.6% for se-
vely evaluated from August 2005 to February 2006, 560 vere sepsis, and 64.8% for septic shock.
were selected due to presence of systemic inflammatory CONCLUSIONS: Sepsis is an important health problem
response syndrome (SIRS) and followed for 28 days or that leads to an extremely high mortality rate in the ICU of
until discharge or death. Patients were categorized ac- Passo Fundo, Brazil.
cording with the etiology of SIRS and further classified Key Words: epidemiology, sepsis, septic shock, severe
as having SIRS, sepsis, severe sepsis and septic shock. sepsis, systemic inflammatory response syndrome.
Prognosis was assessed by means of APACHE II and
SOFA. Mortality was compared in different etiologies of RESUMO
sepsis, APACHE II and SOFA scores, parameters.
RESULTS: Of the 971 patients admitted to the ICU, 560 JUSTIFICATIVA E OBJETIVOS: Sepse é a principal
causa de morte em pacientes tratados em unidade
1. Specialist in Intensive Care, Associação de Medicina Intensiva de terapia intensiva (UTI). O objetivo deste estudo foi
Brasileira. avaliar etiologia, fatores prognósticos e mortalidade de
2. Professor, Medical Clinics, Universidade de Passo Fundo.
pacientes sépticos tratados nas UTI de Passo Fundo,
3. Resident, Department of Medical Clinics, Hospital da Cidade de
Passo Fundo. Brasil.
4. Resident, Department of Medical Clinics, Hospital São Vicente de MÉTODO: Foram avaliados 971 pacientes consecuti-
Paulo, Passo Fundo. vos prospectivamente, entre agosto de 2005 e feverei-
*Received from Hospital da Cidade de Passo Fundo (HCPF), Hospital ro de 2006, 560 foram selecionados pela presença de
Prontoclínica (HP) and Hospital São Vicente de Paulo (HSVP), Passo síndrome da resposta inflamatória sistêmica (SIRS) e
Fundo, RS acompanhados por 28 dias ou até a alta ou óbito. Os
Presented in February 19, 2008
pacientes foram classificados de acordo com a etiolo-
Accepted for publication in April 13, 2008 gia da SIRS e adicionalmente classificados como tendo
SIRS, sepse, sepse grave e choque séptico. O prog-
Address for correspondence:
nóstico foi avaliado por meio dos escores APACHE II
Fernando Zanon, M.D.
Rua Paissandu, 488/402 - Centro e SOFA. A mortalidade foi comparada em diferentes
99010-101 Passo Fundo, RS, Brazil etiologias de sepse e parâmetros APACHE II e SOFA.
Phone: +55-54-30457217 RESULTADOS: Dos 971 pacientes admitidos nas UTI,
560 desenvolveram SIRS (58%). A causa mais fre-
©Associação de Medicina Intensiva Brasileira, 2008 qüente de internação foi doença neurológica (28.9%),

128 Revista Brasileira de Terapia Intensiva
Vol. 20 Nº 2, Abril/Junho, 2008

but. bruary 2006. 750 million admissions in the US in 22 years. whose 64. immunosuppression. Demographic data. O dy included patients at the time of diagnosis of SIRS tempo médio de permanência foi 6 (3-11) dias e a taxa (time zero). Patients could change from one severity stage to the tals in Passo Fundo. ICU studied are located in three hospitals: Hospital da Unitermos: choque séptico. a ciosa. In 2001. This study was approved by the Ethics 1990. They have from 90 to 550 hospital beds. Angus et al. ICU length of stay. increase because of population ageing. severe sepsis. SEPSIS IN THE INTENSIVE CARE UNIT: ETIOLOGIES. and septic shock. Brazil. and found mor. with a mortality rate of 28. Another study conducted in Brazil analyzed II scores were calculated in the first 24 hours of hos- data from 75 ICU in different regions. death. epidemiologia.1% para sepse.1% para SIRS não infec. 20 Nº 2. Brasil. síndrome da resposta inflamatória sistêmica (HP) and Hospital São Vicente de Paulo (HSVP). other. found sion in the study. PROGNOSTIC FACTORS AND MORTALITY o mais freqüente local de infecção foi o trato respira.2% in mission. sep. the American College of Chest Physicians and the So- This study evaluated epidemiologic data and mortality ciety of Critical Care Medicine (ACCP/SCCM) in 199117. rates of patients with sepsis in the ICU of three hospi. 10.5 studied over six and developed systemic inflammatory response syn- million records of hospital discharges in seven states in drome (SIRS)17 while in the ICU. the neighboring state of Santa Catarina. Each severe sepsis per year. therefo- Revista Brasileira de Terapia Intensiva 129 Vol.7/100000 inhabitants in 2000. and this trend is were classified according to 4 stages: non-infectious expected to accelerate in the future5. the Center for Disease Control and Prevention in Research Committee of UPF. where Passo Fundo is located. APACHE shock12. 22. O escore APACHE II This prospective multicenter observational cohort stu- médio foi 18 ± 9 e o escore SOFA médio foi 5 ± 4. and two of them are INTRODUCTION university hospitals affiliated with the Universidade de Passo Fundo (UPF) and the Brazilian Health System Sepsis is an important cause of hospitalization and the (SUS).9% and 52. and 65. Exclusion criteria were: the US and found an estimate of 751 thousand cases of ICU stays shorter than 24 hours.000).2%). 2008 . and pregnancy. and found A questionnaire was used to collect data and to keep more than 10 million cases of sepsis and an increase in uniform records for the three ICU. and source of infection were collected. The Brazilian Sepsis Epidemiolo. Overall mortality rates When a variable was absent. it was classified as nor- for sepsis have decreased. Hospital Prontoclínica se grave. and 9 main cause of death in intensive care unit (ICU)1-3. the use of immunosuppressive drugs and mortality rate were also used for the analyses. In to 22 ICU beds. 34% for severe sepsis. naire and definitions of all variables was handed out ported that the prevalence rate of sepsis in ICU ranged to all researchers.6.1%: 6. sepse. in Passo Fundo (population.6%. sepsis. Few studies in. e os germes mais prevalentes foram os bacilos gram-negativos (53. are mal and a value of zero was entered for that variable.6%). METHODS tório (71. of sepsis per year and over 100 thousand deaths in the Patients were included if they were 18 years or older United States4. The general talidade nas UTI de Passo Fundo. still unacceptably high14. but did not go back to a previous stage.3% for septic shock13. 46. the cause of ad- mortality rates of 11%. SIRS. and the tality rates of 16. The incidence of sepsis has The use of antibiotics. Cidade de Passo Fundo (HCPF). and ICU procedures.7% for sepsis. and all patients or their (CDC) estimated an incidence of 450 thousand cases legal guardians signed an informed consent term. SOFA patients with SIRS.6 reviewed data on hospital discharges for study. SOFA scores16 were calculated daily during ICU stay. pitalization according to the Knaus method15. discharge from ICU. hospitals provide care to the population living in the CONCLUSÕES: Sepse é um importante problema de northern area of this state and in the western region of saúde que leva a uma taxa extremamente alta de mor. at 20% to 80%. A manual with de- frequency to 82. Studies tailed information about how to fill out the question- conducted in Europe. more invasive laboratory culture results. predisposing factor for infection.1% to 30%7-11. conducted in five ICU. Abril/Junho. ding to the definitions established by the consensus of te of Rio Grande do Sul. accor- vestigated the epidemiology of sepsis in ICU in the sta. The patients were followed up until from 5. Brazil. Patients increased prevalence of HIV infection. severe sepsis and septic score. 180.6% para sepse grave e city in the State of Rio Grande do Sul. or the 28th day after inclu- gical Study (Bases Study). It was conducted form August 2005 to Fe- de mortalidade foi 31. new admission was classified as a new patient in this Martin et al.9%. APACHE II score. The three are tertiary general hospitals. sepsis. Australia and New Zealand re. 33.8% para choque séptico.

90 and 8. which corres. MICHEL ET AL. and infectious causes.1%) and renal (37.9%) developed infection. the Mann. frequently were cephalosporin (48.3%) and beta-lactamic antibiotics (26.001).4%). in 1.8 for area under the 3 or more organ failures (p < 0. neuro- Whitney test.4% of the patients. sepsis. a cut- fined according to the consensus of the ACCP/SCCM. sepsis. inclusion in the study.7 ± 18.7%. Enterobacter sp and Acinetobacter sp) in 53. where younger than 18 years. 60. for 71. Mean first and last SOFA Statistical Analysis scores of patients that survived was statistically diffe- Data are presented as mean ± SD. and septic shock of SIRS. The authors did not play any role in the decisions made 27.12. se. res. classified according to stages was 6 (2-14). 24 ± 9 (p < 0.1%.5% were men. Abril/Junho. 73%. The antibiotics used most patients consecutively admitted to the ICU were eva. tic shock were 3.7% of all cases tious SIRS. as excellent18-20. under the curve was 0.8 and 0.3% of significance was set at p < 0. ZANON.7 to 0. or data were ventilation in 51%. in 24% of the patients. their data might be entered in more than one stage.8% 13. and mechanical stayed in the ICU for less than 24 hours.734 ± 0. vere sepsis and septic shock were found in 36.0 for Windows (Chicago.5. cultures were tween 0.3%. and gram-positive cocci (Coagulase-ne- for HSVP.8% (Table 2).4%). 2008 .1%. 414 (73. clinical ICU mortality was 31. Mean pinal fluid.6% and 64.6 years. and median ICU stay of patients admitted to the ICU due to neurologic (29. Overall median number of days in missing from their records (Figure 1). 10. During the study. ponds to a prevalence rate of 58%. 971 cases.0%). 34. and 56. agents (36. most frequent symptoms of SIRS were tachycardia Clinical concepts and criteria introduced in the last (82. antianaerobic luated.1%.8% of the cases of infectious SIRS.3%) or surgical (17. in 28.4%.1% of the cases.5 was established as the value to obtain Infection was defined as the presence of pathogenic good sensitivity (67. CAOVILLA. severe sepsis and sep- infection treated with antibiotics or not17. and the most frequent sites of infection statistical analyses.1% of all cases.1%). and fungi. urine (18. cerebros. re. Mean age was Only one antibiotic was used in 26. severe sepsis and septic shock were de. 55. 22. and values between 0. Patients were the ICU was 6 (3-11). and 560 met inclusion criteria. and the Fisher logic (42.8% and 35.7%). for no survivors. The evaluate the or more organs was found for 36. The SPSS the cases. Percentages of total nosa. for no normal variables. Overall piratory (24. was 6. The by the patients’ attending physicians.4 ± 3. for survivors.7%) and were positive in 50.3%) and tachypnea (80%). Failure in 3 Exact test. tients. The level of statistic made for 340 (60. sepsis.6% for patients with ty. Non-infec.8% in patients with used. 130 Revista Brasileira de Terapia Intensiva Vol. and classification of inflammatory events in patients in ICU. 20 Nº 2.6%.2% number of admissions were 50. Mortality for non-infec- tious causes were responsible for 28. were most common in the respiratory (60.8% of the patients were 2. Nosocomial infection was found in 53.001) (Figure 3). System or organ failures to analyze normally distributed variables.02 (Figure 2). nasogastric catheter in did not develop SIRS. area microorganisms in any sterile medium (blood. 36. severe sepsis. affiliated with the Brazilian Health System (SUS) had More than one pathogen was identified in 2.1%) systems.8% of the 87% of all admissions (Table 1).4%). three or more.3%. median (interquartile rent from mean first and last SOFA score of no survi- range) and percentages. According to the SIRS. and ascetic fluid) or the clinical suspicion of SOFA scores for SIRS.6% and 13% of the cases. urinary tract (4%) and surgical wound (3. central venous catheter in 61%.8% and blood (12.1) problems. older than 60 years.6%).65. The Student t test was used vors (p < 0.99. 4. were the lungs (71.9. Overall mean SOFA score was 5. for categorical variables.8%). and on the 28th day after causes were found for 76. discriminatory power of APACHE II scores for mortali. The two teaching hospitals gative Staphylococcus and Staphylococcus aureus). HCPF and HP. off point of 18. mortality rate ranged from 14. The most frequent pathogens were gram-ne- This study was conducted in the general ICU of three gative bacilli (Escherichia coli. be. sepsis.001). it was 15 ± 8.6%) and specificity (67.6%. a receiver operation characteristic curve (ROC) was fewer than 3 organ failures to 59. receiver operating characteristic (ROC) curve. Positive cultures were most frequently RESULTS obtained from sputum (23%). Pseudomonas aerugi- hospitals in Passo Fundo Brazil. US) software was used for of the cases.05 (two-tailed). Four hundred The most important infection risk factors were urethral eleven patients (42%) were excluded because they catheter in 87% of the cases. Overall mean APACHE decade to define SIRS established a more accurate II score was 18 ± 9. 2. Of all study pa- curve were classified as good discrimination and .

Comparison of Mean First and Last SOFA Scores of Figure 2 – APACHE II Score: ROC Curve for ICU Mortality. SEPSIS IN THE INTENSIVE CARE UNIT: ETIOLOGIES. PROGNOSTIC FACTORS AND MORTALITY Figure 1 – Patients Admitted to the Three ICU and Mortality Rates. Figure 3 . Abril/Junho. 20 Nº 2. 2008 . Surviving and Non-Surviving Patients. Revista Brasileira de Terapia Intensiva 131 Vol.

0 (3-5) < 0.20. ZANON.16.8%. Nosocomial infectiona 53.001b our study.10 found mortality rates of 7% and 26.8 mean APACHE II score was 18 ± 9. difference was statistically significant (p < 0. b Median and interquartile range. Table 1 – Demographics and General Data. and a greater score was associated with gre- Table 2 – Data of Patients that Survived and Patients that Died. APACHE II scores were significantly associated with death.0 for septic shock.3 of 34.1% and a rate HCPFa (patients) 36. CAOVILLA.2% Gram negative 53. se reported in a study conducted by Vincent et al.1%.1) quate to obtain good sensitivity (67. sepsis.1 milar to those reported in the literature25.4 14.13. The SOAP study21. HSVPa (patients) 50. it a was 15 ± 8.6 Male sexa 55 patients with sepsis reported general mortality ra- Infectious SIRSa 71.2% Mortality on 28th daya 34. Rangel-Frausto et al. A cut-off point of 18 was Variables Survivals Deaths p found using the ROC curve. a value that was ade- Number of patients (%) 386 (68.5% to 53.6% 1.2 Salvo et al.5 groups of non-infectious SIRS.0 dy (p = 0.3% for septic shock12. Some Last SOFA score 2±2 10 ± 5 < 0.6%). 34.8 ± 16.0 Surgical wound 3. In our study.6%.13.001) b Fisher exact test. This is the first prospective study in our region to 59.0220 (Figure 3).001c last SOFA scores of survivors and no survivors reve- a Student t test. These findings are similar to tho- analyze the occurrence of sepsis in patients ad.4 Brazilian studies reported mortality rates of 11.6 Septic shock mortalitya 64. MICHEL ET AL. Brazilian Non-infectious SIRSa 28. Studies in Europe and the US with Age (mean ± SD) 60.001 a studies reported that it successfully predicted ou- Mean number of organ 1.21.6% SOFA score was associated with overall mortality in ≥3 40. When patients were divided into Severe sepsisa 24. and 46% and 82% Urinary tract 4. and for no survivors.2 for severe sepsis and of 54.0 (2-4) < 0.9) 174 (31.4 sis or septic shock.3 ± 19. Lung 71.6 to 65. 20 Nº 2. Overall Severe sepsis mortalitya 22.26.001c tcome for their patients19. and 52.24 and Community infectiona 46.6% on the 28th day after inclusion in the stu- HPa (patients) 13.6%) and spe- Mean age (years) 59. Gram positive 30.0 (3-11) for non-infectious SIRS.001 a Greatest SOFA score 5±4 12 ± 5 < 0.7 studies found a general ICU mortality rate of 21. (Table 2).7 ± 18. and those with three or more.1%.21-23.0 and 46.27 failures failed to demonstrate the efficacy of APACHE II as Organ failures (%) a predictor of mortality of patients with sepsis. The ≤2 85.8% < 0.5% Infection sitea for non-infectious SIRS. of 16. The use of the APACHE II score First SOFA score 4±2 8±4 < 0. 36% and 16% for sepsis.734 ± APACHE II 15 ± 8 24 ± 9 < 0.0 (4-6) 5. area under the curve was 0. and the Percentage.7 an overall ICU mortality rate of 31.9% for severe sepsis.0 (0-2) 3. results that are similar to those reported in Brazilian and European studies14.8% Sepsisa 32.6 0. The comparison of means. 24 ± 9.3 tes that ranged from 13.4% to 46. found a mortality rate of 32.001 a as a predictor of mortality is controversial. conducted in Pathogensa 198 ICU in Europe.2 59. severe sep- Septic shocka 31.7 20% and 52% for severe sepsis. This study found a high frequency of sepsis. ater likelihood of death.1% for septic shock. for survivors. Abril/Junho. ICU mortality rates were 6. Our overall mortality Non-infectious SIRS mortalitya 6. 22% and 64.001a 0.008a cificity (66.9% for sep- Overall mortality in ICUa 31.3 63.237).1 sis.001). but Lundeberg et al.3% Length of ICU stayb 6.7% to 33.4% 12. DISCUSSION patients with two or fewer organ failures had a mor- tality rate of 14. aled a statistically significant difference (p < 0. 132 Revista Brasileira de Terapia Intensiva Vol. c Mann-Whitney test.8% (p < 0.26.001). mitted to the ICU. Sepsis remains a global medical Variables General challenge and one of the main causes of death in Total number of patients (n) 560 ICU.8 10. 2008 . of the first and Length of ICU stay (days) 6.1 rates and rates according to sepsis stages were si- Sepsis mortalitya 10.

Bone RC.101:1644-1655. literature12. The SOFA (Sepsis-related Or- gan Failure Assessment) score to describe organ dysfunction/failure. 2002. As the prevalence of infections may be affected sepsis and septic shock. Salvo I. Alberti C. Epidemiology of severe sepsis in the United States: analysis of incidence. Sepsis in European intensive care units: results of the SOAP study. et al. 2007. 2003.7:R117-R122. Angus DC. 1996.3%. logy of sepsis in the US and reported that gram. Crit Care Med. and 16. 2008 . and 02.81:1630-1635. Bellomo R.30:589-596.7%. Brady AR. N Engl J Med.8:R251-R260. disease classification system. failure and guidelines for the use of innovative therapies in sepsis. 22. severe ary). Martin et al.Using severity measures to describe high performance intensive care units. PROGNOSTIC FACTORS AND MORTALITY in which patients without any organ dysfunction REFERENCES had a mortality rate of 6%. 17. the stu. Eddleston JM . minary results on the incidence and evolution of SRIS. Chest. of the cases. et al. and as- patients on mechanical ventilation or immunosup. 2006. Efficacy and safety of re- gre for the help provided in the analysis of data. long-term morbidity and mortality.2% tensive Care Med. in 1. which is in agreement with findings in the 1990. Padkin A. Guyatt G. Crit Care Med. Finfer S. whereas those with 4 or 01.6 studied the epidemio. 2003. Hatum R. Draper EA. Takala J. 07. and found a high prevalence of sepsis and an lege of Chest Physicians/Society of Critical Care Medicine.6%). similar to those reported 09. SEPSIS IN THE INTENSIVE CARE UNIT: ETIOLOGIES. 2001.4%. sepsis.The importance of assessing the fit of logistic regression models: a case study. Crit Care Clin. Brunkhorst FM.13:818-829. et al.21:(Suppl2):S2- 44-S249. et al. et al. In- tensive Care Med. 1996 to 2004: secon- dary analysis of a high quality clinical database. Brun-Buisson C. outcome. The epidemiology of sep- of patients not on ventilation or immunosuppressed sis in the United States from 1979 through 2000. 2006. Assessment of six mortality ACKNOWLEDGEMENTS prediction models in patients admitted with severe sepsis and septic shock to the intensive care unit: a prospective cohort study. Teres D. the International Sepsis Forum.22:707-710. sepsis. 1993. Outcome measures for clini- cal research in sepsis: a report of the 2nd Cambridge Colloquium of fungi. Moreover. and Northern Ireland. United States. studies should include a larger number of patients 18.168:165-172. Vincent JL. Abril/Junho. 19. 2004.263:937-938. (71. 15. Lidicker J.28. 2003. Research Group of Hospital de Clínicas de Porto Ale. (47. sociated costs of care. Crit Care. Aegerter P. 40. 2006. Median length of severe sepsis in Australian and New Zealand intensive care units. 1985. the ICNARC Case infections or even of sites of infection29. The Italian SEPSIS study: preli- conducted in a period of 6 months (August to Febru.21. 2003. Sogayar AC. et al. Sales Junior JA. gram-positive bacteria. ICU stay was 63. which receives patients only from parts of Med.The epidemiology of severe te the actual prevalence of germs that cause such sepsis in England. Vincent JL. N Engl J Med. Sepse Brasil: estudo epi- may have failed to demonstrate actual middle.344:699-709. Bone HG. Crit Care Med. Am J Respir Crit Care Med. Vincent et al. European Society of Intensive Care Medicine. In- study. occurring in the first 24 hrs in intensive care units in England. limitation was that patients were followed up only up 12. few studies investiga. Goodman SV. Crit Care Med. Jars-Guincestre MC. This study described the epidemiologic profile of pa. The most frequent site of infection was the lungs 04. et al.29:1303-1310. to the 28th day after inclusion in the study.10:R42. de Cian W.018).4-10 days. Epidemiology of sepsis p = 0.18:9-17. pressed patients was significantly greater than that 06. 2001. One of the limitations of this study was that it was 10. 2003. 1979-1987. Crit Care Med. et al. Cerra FB. Goldfrad C. Wagner DP. Al Shirawi N.21 also found a significan. Linde-Zwirble WT. We are grateful to the statisticians of the Graduate 21. ill infected patients. tly greater mortality rate for patients on mechanical 08. Vincent JL. Silva E. Future 1992. Knaus WA. Mannino DM. APACHE II: a severity of two Brazilian states. However. Rev Bras Ter Intensiva. Laterre PF. this study may have failed to demonstra.34:344-353. et al. Wales and Northern Ireland. 2005. Engel C. and infection in ICU patients from an international multicentre cohort study. unacceptable high mortality rate in the region. Intensive Care Med. and data 13. Vincent JL. Martin GS. Am J Public Health. 03. et al. gram-negative bacteria were found in 53. Revista Brasileira de Terapia Intensiva 133 Vol. Lemeshow S . Balk RA. et al.13.348:1546-1554. et al. David CM. Moreno R. Intensive Care Med. et al. The ACCP/SCCM Consensus Conference Committee. Memish Z. Am J Respir Crit Care Fundo. et al. combinant human activated protein C for severe sepsis.8. Bernard GR. Epidemiology of severe sepsis in the literature5. in 30. Intensive Care Med. Harrison DA. Taber S. 20. 11. Eaton S.6% and 18. Brazilian Sepsis Epidemilo- gical Study (BASES study). 1995. 2004. Annane D. et al. ted the epidemiology of sepsis in Brazil before. In this Germany: results from a national prospective multicenter study. Crit Care.Increase in national hospital dischar- ge survey rates for septicemia. Alberti C.9:543-554.31:2332-2338. Lemeshow S . 14. Burchardi H. et al. American Col- Brazil. this is the first study on the epidemiology of sepsis On behalf of the Working Group on Sepsis-Related Problems of the in this region. et al. Arabi Y. Hosmer DW.28:108-121. et al. Centers for Disease Control .30. Epidemiology of sepsis in more organ dysfunctions had a rate of 65%. by season.33:606-618.001. Lipman J. Crit Care. Current epidemio- dy was conducted in only 3 ICU in the city of Passo logy of septic shock: the CUB-Rea Network. Sakr Y. Sprung CL.168:77-84.33:1708-1716.and demiológico da sepse em unidades de terapia intensiva brasileiras. and ICU to better understand and treat patients with 1991.9% and 28. JAMA. Wales. Marshall JC. Influence of systemic inflammatory response syndrome and sepsis on outcome of critically positive bacteria were the most frequent in the ICU. Another Mix Programme Database. Brun-Buisson C. 20 Nº 2.2% p < 0. Musicco M. The mortality rate in the group of 05. Pedro Mde A. Welch CA. Definitions for sepsis and organ tients with sepsis in ICU in the city of Passo Fundo. Adult-population incidence of ventilation or immunosuppressed.

The natural history of care units. Carlet J. Brun-Buisson C. EPISEPSIS: a reappraisal study. Ruokonen E. of the epidemiology and outcome of severe sepsis in French intensive 25. et al. Presneill JJ. 2008 .14:85-94. French ICU Group for Seve. et al. Brun-Buisson C.345:1368-1377. et al. 23. Varpula M. and care units. outcome for patients with onset on hospital wards versus intensive 24. MICHEL ET AL. 2004. Epidemiology of prospective study in intensive care units. Rev Bras Ter Intensiva. 1998. Avaliação do risco de outcome of severe sepsis in ICU-treated adults in Finland: the Finn- mortalidade através do APACHE II para o CTI de um hospital escola sepsis study. ZANON. Australia. 30. Intensive Care Med. A prospective 28. et al. risk factors. Perl TM. A multicenter 29. 134 Revista Brasileira de Terapia Intensiva Vol. Rangel-Frausto MS. et al. Intensive Care Med.274:968-974. Crit Care Med. Incidence. 2005. 1995. in the treatment of severe sepsis and septic shock. 20 Nº 2. Cardoso LTQ. Macisaac CM. Matsuo T. Lundberg JS. Incidence. et al. Meshaka P. et al. Rivers E. Sundararajan V. 27. Havstad S. 2002. sepsis in Victoria.26:1020-1024. Pinton P. re Sepsis. Doyon F. Pittet D. et al.30:580-588. treatment.33:71-80. CAOVILLA. Costigan M. JAMA. Nguyen B. Wiblin T. 1995. Abril/Junho. Crit Care Med. Bonametti AM. JAMA.33:435-443. and 26. the systemic inflammatory response syndrome (SIRS).273:117-123. outcome of severe sepsis and septic shock in adults. Septic shock: an analysis of 2001. Early goal-directed therapy publico. Karlsson S. N Engl J Med. 2007.