Sepsis is one of the leading causes of death among critically ill patients, with its massive disease burden making it a pressing global health challenge. Under the leadership of Vice President Du Bin and Professor Liu Dawei, the Critical Care Medicine Center of PUMCH has achieved significant breakthroughs in sepsis treatment. Professors Du Bin and Weng Li established China's sepsis burden assessment system, while Professors Liu Dawei and Zhou Xiang developed China's critical care quality control system. Based on this quality control framework, the team established key technologies and systems for sepsis treatment, substantially improving sepsis prognosis in China. The project has been implemented throughout Beijing and nationwide and was granted second prize of the 2023 Beijing Science and Technology Progress Award.
Understanding the Disease Burden
Sepsis, a clinical syndrome where severe infection leads to multiple organ failure, is the fourth leading cause of life loss among Chinese patients, resulting in poor quality of life and poor long-term prognosis. The team was the first to report the epidemiological characteristics and disease burden of Chinese sepsis patients in ICU, revealing three key features: high incidence, high mortality, and heavy disease burden. From 2006 to 2020, China's sepsis burden showed a declining trend, with mortality rates dropping from 130.2 to 76.6 per 100,000 population, and years of life lost decreasing from 2,172.7 to 1,271.0 per 100,000 population.
Building a Four-Tier Network
Sepsis places an enormous strain on healthcare resources, and the significant variations in ICU care standards across China highlighted the urgent need for standardized treatment protocols. In 2012, PUMCH was designated as the National Critical Care Quality Control Center. Following this appointment, PUMCH led China's critical care medicine transformation, shifting focus from expanding capacity to enhancing quality of care. From the ground up, they progressively developed a four-tiered quality control network - linking national, provincial, municipal, and hospital levels. With Beijing serving as the central hub, this network now encompasses more than 500 sentinel hospitals across the country.
Mapping the National ICU Landscape
Over nine years, the team has built an extensive database encompassing quality and safety metrics from ICU care, covering more than 1 billion ICU patient-days and 14 million ICU patients. This comprehensive data spans critical illness categories and key technologies. The team innovatively established a nationwide ICU quality control organizational system with a systematic sampling approach for monitoring healthcare quality and safety, providing an unprecedented view of ICU care quality across China. In 2019, China's first dedicated sepsis surveillance and management platform was launched. As of November 27, 2024, this platform has documented over 880,000 sepsis cases nationwide, gathering firsthand data on sepsis treatment, hospital infection prevention, and ECMO management. This robust database now serves as the foundation for standardizing septic shock treatment and enabling dynamic monitoring and intervention nationwide.
Standardizing Quality Control
Based on comprehensive research and data analysis, the team developed China's quality control evaluation system. In 2015, they led the establishment of 15 quality control evaluation standards for critical care, creating unified measurements for ICU quality nationwide. The team continues to refine these indicators, leading provincial quality control centers in updating critical care quality control metrics in 2024.
The team identified the "3h/6h bundle completion rate for ICU septic shock" as a key indicator of process quality control. Early implementation of bundled treatment protocols, including obtaining blood culture before antibiotics, lactate measurement, and broad-spectrum antibiotic use, effectively reduces sepsis mortality. Additionally, the project established three management systems for sepsis in China: quality control, disease burden assessment, and mortality/incidence estimation.
Implementing the "Three Unifications"
With the focus on Beijing, the project team has been promoting comprehensive ICU quality improvement through "three unifications": implementing unified platform, standards, and evaluation metrics in secondary and higher-level medical institutions across the city. This approach ensures standardized training, application and continuous improvement, establishing a precise, standardized sepsis treatment network citywide. Since implementation, Beijing's secondary and higher-level hospitals have shown significant improvements in sepsis treatment outcomes, with significant decreases in both mortality and disability rates: from 2010 to 2017, relative mortality rates for septic shock decreased by over 10%, ICU costs reduced by approximately 20%, and average ICU stays shortened from 9 to 4 days.
The project team has published more than 40 high-quality research papers on critical care quality control, earning high praise and recognition from the international medical community. Their findings have become key references in the development of international sepsis guidelines. Currently, they are promoting these key sepsis treatment technologies nationwide to continuously improve China's sepsis care standards. This research received support from the National High Level Hospital Clinical Research Funding and the National Key R&D Program of the Ministry of Science and Technology.
Written by the Critical Care Medicine Center and the Publicity Division
Picture courtesy of the Publicity Division
Edited by Fu Tanping and Chen Xiao