2 per 100 admissions [3], with the authors reporting an increase over the period from 7.0 in 1993 to 9.7 per 100 admissions in 2000. Mean mortality over the same http://www.selleckchem.com/products/U0126.html period was 60.1%, with a decreasing trend from 62.1% in 1993 to 55.9% in 2000. The increasing incidence and high mortality observed by Annane et al. was partially explained by the increasing age of patients admitted to the ICU over the period under study, with ever more co-morbidities, particularly immunosuppression.Recent studies from various countries around the world have reported mortality rates from 35% to 59% (in-hospital or at 30 days) [5,6,8,18,36], albeit with study populations that were more heterogeneous than that included in our study.

Our results are especially important in that they were prospectively collected in a broad mix of ICUs in a contemporary period over 18 months, after the publication of several major trials related to treatment of sepsis likely to have influenced management [37-39]. In these recent interventional studies, the hospital mortality rates reported in the control group ranged from 46.5% to 69% and from 30.5% to 60% in the treatment groups [37,39]. The 28-day mortality was also different in these recent interventional studies, reportedly ranging from 24% to 61% in the control group, and from 24.7% to 55% in the treatment group. The difference was explained by the inclusion and exclusion criteria, and the severity at inclusion, which may not have accurately reflected ‘real life’ patient populations.In recent years, several sets of guidelines have been issued and updated on the management of sepsis in the setting of intensive care [19,23].

In addition, national guidelines have been issued in France jointly by the two French scientific societies in critical care (Soci��t�� de R��animation de Langue Fran?aise (French-language society of intensive care, SRLF, and Soci��t�� Fran?aise d’Anesth��sie R��animation) in 2006 [20,21]. The implementation of these recommendations in practice has favorably influenced patient prognosis, as reported in several studies, particularly due to earlier recognition of the severity of disease, followed by consistent, multidisciplinary management [22,23,40,41]. Other authors have reported a reduction in mortality in-hospital or at 28 days, after the rigorous implementation of such guidelines [41,42].

Our data show that mortality in the ICU decreased by approximately 17% between 2000 [3] and the period 2009 to 2011 (inclusion period of our study), for patients with septic shock and comparable severity Batimastat at admission (mean SAPS II score of 56 in the study by Annane et al. vs. 58 in our study). These data suggest that management has improved over the last decade, and undoubtedly, the publication of international clinical practice guidelines for management contributed to this trend, although a recent study by Leone et al.