Published: 2020-03-26

Epidemiology of sepsis and its various characteristics in a tertiary care adult-multidisciplinary ICU in South India: a retrospective study

Hussain Khan Tharappel Jalal, Teju P. Thomas, Alfy Ann George, Hamadan Mohammed


Background: The incidence of sepsis is increasing, especially in elderly populations with more comorbidities. It is now estimated that sepsis is a leading cause of mortality and critical illness worldwide. The Epidemiological data regarding sepsis, septic shock and organ involvement is mainly from western literature. Data from India, especially south India, are less when compared to western data. In this background authors conducted a retrospective study in tertiary care hospital in south India. Objectives of the study was epidemiology of sepsis and its various characteristics in a tertiary care adult-Multi disciplinary ICU in South India.

Methods: This study was a retrospective observational study, conducted during the time period of June 2016 and May 2017. The study population was patients above 18 yrs admitted in MDICU with sepsis. The study was conducted in a tertiary care adult -Multidisciplinary ICU in South India. Various characteristics like age group, comorbidities, organ involvement, septic shock, sofa score, need for ventilatory support, RRT support and outcome data was collected.

Results: In this study, 497 patients who satisfied the Surviving Sepsis Campaign guidelines were included. The majority of the patients (59.8%) were male; the majority was above 60 yr (range 18 to 92 yr). 76.3% Patients had comorbid disease. Hypertension was the most common co-morbid (62%) followed by diabetes mellitus (51.3%). Chronic Kidney Disease was found in 132 patients (26.6%) and Coronary artery disease in 121 patients (24.3%). 186 patients (46.5%) had single organ involvement 140(35%) patients had 2 organ involvement. 74(18.5%) patients had more than 2 organ involvement. Septic shock was found in 155 patients (31.2%). Renal involvement was the most common organ involvement found in 279 patients(59.9%). Most common source for sepsis was the respiratory system found in 230 patients (46.3%), followed by urinary tract infection in 117 patients (23.5%). The study shows a significant association between SOFA score and mortality (p-value 0.001) 52% of mortality happened in group of patients with SOFA score more than 15 and mortality was 28 % in group with a SOFA score of 10-15.

Conclusions: In this retrospective study of sepsis, authors found that the most common source of sepsis was pneumonia (46.3%) followed by urinary tract infection (23.5%). Majority of the patients had one organ involvement (46.5%). Among the organ involvement, Acute Kidney injury was the most common organ involvement (56.1%) followed by septic shock (31.2%) and respiratory support (29.6%). Mortality in this study was higher with higher SOFA score.


MODS, Organ involvement, Sepsis epidemiology, SOFA

Full Text:



Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.

Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ. 2016;23;353:i1585.

Wong HR, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, et al. Developing a clinically feasible personalized medicine approach to pediatric septic shock. Am J Resp Criti Care Medi. 2015 Feb 1;191(3):309-15.

Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intens Care Medi. 2004 Apr 1;30(4):536-55.

Vincent JL, Marshall JC, Ñamendys-Silva SA, François B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Resp Medi. 2014 May 1;2(5):380-6..

Chatterjee S, Bhattacharya M, Todi SK. Epidemiology of adult-population sepsis in India: a single center 5 year experience. Ind J Crit Care Medi: Peer-revi, Offic Public Indian Soci Criti Care Medi. 2017 Sep;21(9):573-7.

Vincent JL, De Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Criti Care Medi. 1998 Nov 1;26(11):1793-800.

The European Society of Intensive Care Medicine (ESICM). Available at: Accessed 14 June 2019.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Critical Care Medicine. 2003;31(4):1250-6.

Babu M, Menon VP, Devi U. Epidemiology and outcome among severe sepsis and septic shock patients in a South Indian tertiary care hospital. Int J Pharm Pharm Sci. 2017;9(5):256-9.

Maurya H, Dubey SK, Bisht P, Semwal M, Gandhi S. An updates on the sepsis causing multiple organ dysfunctions. J Crit Rev. 2016;3:31-40.

Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X, et al. Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PloS one. 2014;9(9):e107181

Khwannimit B, Bhurayanontachai R. The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiol Infect. 2009 Sep;137(9):1333-41.

Case J, Khan S, Khalid R, Khan A. Epidemiology of acute kidney injury in the intensive care unit. Critical care research and practice. 2013;2013.

Prakash J, Singh TB, Ghosh B, Malhotra V, Rathore SS, Vohra R, et al. Changing epidemiology of community-acquired acute kidney injury in developing countries: analysis of 2405 cases in 26 years from eastern India. Clini Kidney J. 2013 Apr 1;6(2):150-5.

Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units. JAMA. 1995 Sep 27;274(12):968-74.

Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006 Jun 1;129(6):1432-40.

Stegenga ME, Vincent JL, Vail GM, Xie J, Haney DJ, Williams MD, et al. Diabetes does not alter mortality or hemostatic and inflammatory responses in patients with severe sepsis. Criti Care Medi. 2010 Feb 1;38(2):539-45.

Peake SL, Bailey M, Bellomo R, Cameron PA, Cross A, Delaney A, et al. Australasian resuscitation of sepsis evaluation (ARISE): a multi-centre, prospective, inception cohort study. Resuscitation. 2009 Jul 1;80(7):811-8.

Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8.

Vosylius S, Sipylaite J, Ivaskevicius J. Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis. Croat Med J. 2004 Dec 1;45(6):715-20.