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Community-onset sepsis and its public health burden : a systematic review
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Tsertsvadze, Alexander, Royle, Pamela, Seedat, Farah, Cooper, Jennifer, Crosby, Rebecca and McCarthy, Noel D. (2016) Community-onset sepsis and its public health burden : a systematic review. Systematic Reviews, 5 . 81. doi:10.1186/s13643-016-0243-3 ISSN 2046-4053.
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Official URL: http://dx.doi.org/10.1186/s13643-016-0243-3
Abstract
Background:
Sepsis is a life-threatening condition and major contributor to public health and economic burden in the industrialised world. The difficulties in accurate diagnosis lead to great variability in estimates of sepsis incidence. There has been even a greater uncertainty regarding the incidence of and risk factors for community-onset sepsis (COS). We systematically reviewed the recent evidence on the incidence and risk factors of COS in high income countries.
Methods:
Cohort and case-control studies were eligible for inclusion. Medline and Embase databases were searched from 2002 onwards. References of relevant publications were hand searched. Two reviewers screened titles/abstracts and full-texts independently. One reviewer extracted data and appraised studies which were cross-checked by independent reviewers. Disagreements were resolved via consensus. Odds ratios (ORs) and 95 percent confidence intervals (95% CIs) were ascertained by type of sepsis (non-severe, severe, and septic shock).
Results:
10 cohort and 4 case-control studies were included. There was a wide variation in the incidence (# cases per 100,000 per year) of non-severe sepsis (range: 64 - 514), severe sepsis (range: 40 - 455), and septic shock (range: 9 - 31). Heterogeneity precluded statistical
pooling. Two cohort and 4 case-control studies reported risk factors for sepsis. In one casecontrol and one cohort study, older age and diabetes were associated with increased risk of sepsis. The same case-control study showed an excess risk for sepsis in participants with
clinical conditions (e.g., immunosuppression, lung disease, and peripheral artery disease). In one cohort study, higher risk of sepsis was associated with being a nursing home resident (OR=2.60, 95% CI: 1.20, 5.60) and in the other cohort study with being physically inactive
(OR=1.33, 95% CI: 1.13, 1.56) and smoking tobacco (OR=1.85, 95% CI: 1.54, 2.22). The evidence on sex, ethnicity, statin use, and body mass index as risk factors was inconclusive.
Conclusions:
The lack of a valid standard approach for defining sepsis makes it difficult to determine the true incidence of COS. Differences in case ascertainment contribute to the variation in incidence of COS. The evidence on COS is limited in terms of the number and quality of studies. This review highlights the urgent need for an accurate and standard method for identifying sepsis. Future studies need to improve the methodological shortcomings of previous research in terms of case definition, identification, and surveillance practice.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > ( - July 2016) Health Education Hub Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Septicemia | ||||||||
Journal or Publication Title: | Systematic Reviews | ||||||||
Publisher: | BioMed Central Ltd. | ||||||||
ISSN: | 2046-4053 | ||||||||
Official Date: | 18 May 2016 | ||||||||
Dates: |
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Volume: | 5 | ||||||||
Article Number: | 81 | ||||||||
DOI: | 10.1186/s13643-016-0243-3 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Description: | SYSR-D-15-00129R2 |
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Date of first compliant deposit: | 28 April 2016 | ||||||||
Date of first compliant Open Access: | 28 April 2016 | ||||||||
Funder: | National Institute for Health Research (Great Britain) (NIHR) |
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