Much attention has been devoted in the literature to the details of sepsis pathophysiology and therapy over the last decade, while severe sepsis and septic shock remain the number one cause of death in critically ill patients. The failure of numerous randomized controlled trials for interventions in severe sepsis has led some to believe that little progress has been made in terms of improving survival. Kaukonen and colleagues sought to estimate trends in mortality in a large cohort of patients in Australia and New Zealand over a 13-year period. The authors hypothesized that mortality rates decreased significantly throughout this time period. Their study affirmed similar findings of decreased mortality among patients with severe sepsis over the last decade. However, the study also demonstrated a decrease in overall mortality among all admitting ICU diagnoses over the same time period. This mortality reduction remained after multiple adjustments for confounders, including illness severity. These findings likely reflect a better understanding of disease processes and therapies in the ICU, whether related to sepsis or not. One potential criticism of this work is that an element of surveillance bias or stage migration (i.e., the Will Rogers phenomenon) might be at play given improved awareness and detection of sepsis. With the decrease in short-term mortality observed in this study and others, future studies examining measures of healthcare-related quality of life and other measures of morbidity are merited.
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