English summary: THE FINNSEPSIS STUDY: SEVERE SEPSIS AND SEPTIC SHOCK AS CHALLENGES FOR INTENSIVE CARE IN FINLAND

Background Severe sepsis is a common problem in intensive care units (ICU) and related with high mortality. No prospective studies had previously been carried out regarding the incidence of severe sepsis and septic shock in Finland. The purpose of the Finnsepsis study was to determine the incidence and outcome of severe sepsis and sepsis-related organ failure, and to evaluate the actual treatment of septic patients.

Methods We conducted a prospective study in 24 closed multi-disciplinary ICUs in 21 hospitals in Finland. All consecutive ICU admission episodes (4500) were screened for severe sepsis during a 4-month period between November 1, 2004 and February 28, 2005.

Results The severe sepsis criteria (ACCP/SCCM 1992) were fulfilled in 472 patients; one patient had two episodes of severe sepsis from the same origin and two patients from different origins. The incidence of severe sepsis in ICUs in Finland was 0.38 /1000 in an adult population (>18 years). The sepsis was community acquired in 58.8% of cases. The source of infection was pulmonary in 42.4% and intra-abdominal in 32% of cases. Septic shock was diagnosed in 77.3%, respiratory failure in 71.7%, and acute renal failure in 23.4% of patients. Activated protein C was given to 15 patients (3.2%) and low-dose hydrocortisone for septic shock to 41% of patients. The ICU, hospital and 1-year mortalities were 15.5%, 28.3% and 40.9%, respectively.

Conclusions In this prospective study the incidence of severe sepsis in Finland was lower than expected. Hospital mortality was quite high but comparable with international studies. The mortality in severe sepsis may be decreased by early recognition of sepsis and more systemic use of treatments and interventions which are known to improve the outcome.

Tästä asiasta tiedettiin - Vaikea sepsis ja septinen sokki on yleinen tehohoidon ongelma, johon liittyy suuri kuolleisuus. - Sepsiksen todellisesta ilmaantuvuutta Suomessa ei ole aikaisemmin kartoitettu. - Vaikean sepsiksen ennustetta voidaan parantaa varhain aloitetulla hoidolla.

Tämä tutkimus opetti - Vaikean sepsiksen ilmaantuvuus on Suomessa vähäisempää kuin monissa muissa maissa. - Sepsiksen hoidon tulokset ovat kansainvälisesti hyvällä tasolla, mutta diagnostiikkaa ja ennustetta parantavien hoitomuotojen käyttöä voitaneen vielä tehostaa ja systematisoida. - Kansallinen tehohoidon tutkimusyhteistyö toimi hienosti ja mahdollisti tutkimuksen toteutumisen.