Sepsis requiring Intensive Care Unit admission

• Main Author: Vésteinsdóttir, Edda
• Other Authors: Sigurbergur Kárason, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: University of Iceland, School of Health Sciences, Faculty of Medicine 2022
• Subjects: Faraldsfræði; Gjörgæslulækningar; Krabbamein; Hjartaaðgerðir; Doktorsritgerðir; Epidemiology; Cardiology; Oncology; Critical care outcomes; Elective surgical procedures; Cardiac surgical procedures; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/3162

Sepsis is a leading cause of admission to intensive care units (ICU) worldwide and mortality rates remain high despite advances in organ support. Awareness of the syndrome has increased substantially in the past 20 years, after the publication of several studies that showed improved outcome with relatively simple measures, such as early administration of fluid and antibiotics. These studies were the impetus for an educational treatment campaign with the goal of reducing mortality from sepsis. Several studies in recent years have shown an increasing incidence of sepsis, and declining mortality rates. Many of those are based on diagnosis codes with risk of bias due to increased use of sepsis codes as a result of this heightened awareness of sepsis. Medical care may contribute to the development of sepsis, not only by weakening host defences with immunosuppressive therapy and surgical procedures, but also on rarer occasions by contamination, highlighting the importance of scrutinous observation of hospital-acquired infections. The overall aim of this thesis was to create a broad overview of sepsis requiring admission to intensive care units in a nationwide cohort in Iceland, with a special focus on several patient groups. Trends in incidence, treatment and outcome were assessed, with special consideration given to cancer patients with sepsis, patients developing sepsis after surgery and the detection of nosocomial infection clusters and their impact. The four studies (I-IV) were retrospective cohort studies using two cohorts of patients. For the first cohort, all ICU admissions in Iceland were screened for the presence of severe sepsis or septic shock on admission during calendar years 2006, 2008, 2010, 2012, 2014 and 2016 using clinical criteria and chart review. This database of sepsis patients (971 patients) was used in studies I,II and III. Additionally, for study III, the number and type of all surgical procedures performed at the largest hospital in Iceland, Landspitali, during the same study years were ...