Epidemiology of sepsis, based on ICD-9 coding, a tertiary care experience from Pakistan

Introduction: There are limited studies on the burden of sepsis, from low to middle income countries (LMIC). We had carried out an analysis of the epidemiology of sepsis, in our hospital, a tertiary care university hospital in Pakistan, based on ICD-9 coding. Materials: Retrospective data from electronic discharge records of all patients aged 17 or above, admitted with sepsis from January 2013–January 2014, at our hospital was taken. A validated method requiring a combination of two ICD-9 codes (international classification of diseases, ninth revision, clinical modification) representing infections and acute organ dysfunction, based on the Angus and Martin methodology, along with ICD-9 codes for sepsis, severe sepsis and septic shock, were used to abstract data. Results: Overall, 8759 patients were identified to have sepsis or severe sepsis, out of total 31,111 admissions between 2013 and 14. Out of these cases, 61.25% (5365) had sepsis while 38.75% (3394) had severe sepsis or septic shock. Out of the total 8759 patients, 58.10% (5089) remained in the ward. 31.93% (2797) utilized the intermediate Care Unit while 9.97% (873) utilized the Intensive Care Unit (ICU). The overall mortality with sepsis, was found to be 9.8% and mortality from septic shock to be around 22.8%. The common comorbidities were diabetes (22.8%), renal disease (14.7%) and COPD (14.7%). The mean length of hospital stay was 3.7 days in mild disease, compared to 7.5 days, in severe sepsis and septic shock group. Conclusions: The first ICD -9 coding-based study signifies a high burden of disease, along with high mortality from septic shock.