Ill members of affected households were three times as likely to use hospitals as ill members of unaffected households (29% vs. 10% of visits), indicating more severe illness Ill members of affected households required more caring support from their households then did ill members of unaffected households.
Using data on 1,735 patients from a single academic medical center, Whittaker and colleagues showed that that the Angus-severe sepsis discharge criteria tend to select for a more severely ill severe sepsis cohort, with increased lactates, rates of ICU admission, Acute Physiology and Chronic Health Evaluation II scores and 28-day mortality [ 5].
The independent prescribers' group may have been more severely ill, because more severe or unstable cases might have been retained by the doctors, whilst the more chronic and stable cases might have been transferred to mental health nurses.
The lack of demonstrated efficacy in the negative studies is not due to enrollment of less severe or more severely ill patients.
These data do not suggest that a possible explanation for the lack of demonstrated efficacy in these studies resulted from either enrollment of less severe or more severely ill patients (as assessed by the observed placebo mortality rates).
Patients who are more severely ill (ie, with more severe PAH or multiple comorbidities) are at higher risk for all-cause hospitalization.
These results may suggest that progression of AKI is more likely when higher doses of norepinephrine are required to maintain targeted blood pressure levels in more severely ill patients with severe sepsis, plausibly by causing excess constriction of regional vascular beds [ 29].
Thus, applying the 2003 definitions instead of the 1992 definitions will create a case mix with more patients with sepsis, especially classified as more severely ill, i.e. with severe sepsis and septic shock.
These observations likely reflect the intention of the International Pediatric Sepsis Consensus Conference to identify a more severely ill subgroup of critically ill children with severe sepsis for enrollment in clinical trials [ 6].
Alternatively, there might be also significant variation in the effectiveness of different types and generations of antibiotics that we termed 'appropriate' collectively, especially among more severely ill patients who are more likely to die or have more severe complications[ 31].
