Weycker Derek, Akhras Kasem S, Edelsberg John, Angus Derek C, Oster Gerry
Policy Analysis Inc., Brookline, MA, USA.
Crit Care Med. 2003 Sep;31(9):2316-23. doi: 10.1097/01.CCM.0000085178.80226.0B.
To estimate long-term mortality and medical care charges among patients with severe sepsis.
Retrospective cohort study.
Large, integrated, geographically diverse, U.S. health-insurance claims database covering three million lives annually.
All persons with bacterial or fungal infections and acute organ dysfunction (severe sepsis) who were hospitalized between January 1, 1991, and August 31, 2000.
None.
All patients were followed from the date of hospitalization with severe sepsis (index admission) to August 31, 2000, disenrollment from the health plan, or death, whichever occurred first. Measures of interest included mortality and medical care charges and were estimated for the index admission, the 90- and 180-day periods following the index admission, and annually thereafter (up to 5 yrs), using techniques of survival analysis. A total of 16,019 patients were identified who met study entrance criteria. Most patients (81.2%) were >/=65 yrs of age; 53.4% were men. Mortality was 21.2% for the index admission, 51.4% at 1 yr, and 74.2% at 5 yrs. Mean cumulative total medical care charges were 44,600 US dollars for the index admission, 78,500 US dollars at 1 yr, and 118,800 US dollars at 5 yrs. Hospitalization accounted for the largest component of total medical care charges.
Mortality and economic costs are high in patients with severe sepsis, during the period of acute illness as well as subsequently.
评估重症脓毒症患者的长期死亡率及医疗费用。
回顾性队列研究。
覆盖美国每年300万人生命的大型、综合、地域多样的医疗保险索赔数据库。
1991年1月1日至2000年8月31日期间住院的所有患有细菌或真菌感染及急性器官功能障碍（重症脓毒症）的患者。
无。
所有患者从重症脓毒症住院日期（索引入院）开始随访，直至2000年8月31日、退出健康计划或死亡，以先发生者为准。感兴趣的指标包括死亡率和医疗费用，并使用生存分析技术对索引入院、索引入院后90天和180天期间以及此后每年（最长5年）进行评估。共确定了16019名符合研究入选标准的患者。大多数患者（81.2%）年龄≥65岁；53.4%为男性。索引入院时死亡率为21.2%，1年时为51.4%，5年时为74.2%。索引入院时平均累计总医疗费用为44600美元，1年时为78500美元，5年时为118800美元。住院费用占总医疗费用的最大部分。
重症脓毒症患者在急性疾病期间及之后的死亡率和经济成本都很高。
