Sepsis in patients hospitalized in Sicily over the years 2016–2020: a retrospective study

Abstract

Abstract Background: Sepsis is a leading cause of in-hospital mortality and morbidity globally. Epidemiological data regarding the incidence and mortality of sepsis are scarcely available. Most reports are based on administrative. Furthermore, sepsis in non-intensive care units has been considered only in a few studies. The present study aimed to describe the epidemiology of sepsis and related outcomes among patients hospitalized in Sicily and analyze the features associated with high mortality. Methods: Data on the discharge forms of all patients with sepsis in all Sicilian hospitals from January 2016 to December 2020 were retrospectively collected. Age, sex, comorbidities, infections, and blood alterations were evaluated using univariate analysis according to in-hospital mortality. The factors associated with mortality were included in the logistic regression model. Results: In Sicily, 15373 hospitalizations associated with sepsis occurred from 2016 to 2020 with a mortality of 36.3%. The percentage of hospitalizations associated with sepsis represented 0.65 % of all admissions with an increase over the years. The diagnosis of septic shock was reported in 42.0%, with a mortality of 67.7%. The average cost and length of stay were EUR 8849 ± 10395 and 18 ± 22 days, respectively. Septic shock was an independent predictor of mortality. Older age was an independent predictor of mortality in adults. Klebsiella pneumoniae, aspergillosis, peritonitis, chronic respiratory failure, and hypernatremia, were independently associated with death in non-Intensive Care Unit (ICU) adult patients. For paediatric patients, gastrointestinal infection was an independent predictor of mortality, and only for non-ICU hospitalizations, diabetes, and anaemia were. Conclusions: In Sicily, sepsis is a significant cause of in-hospital mortality, especially for ICU-admitted patients and patients with septic shock. From 2016 to 2020, there was an increase in hospitalizations with sepsis, mortality associated with sepsis and septic shock diagnosis. Hospitalizations associated with sepsis presented high charges, especially for ICU-admitted and septic shock diagnoses. Septic shock was an independent predictor of mortality for all patient groups. Older age, chronic respiratory failure, peritonitis, Klebsiella pneumoniae infection, aspergillosis, and hypernatremia were associated with higher mortality in non-ICU admitted adults, while diabetes, anaemia, and gastrointestinal disease for children non-ICU admitted.