患有严重脓毒症的住院癌症患者：发病率、死亡率及相关护理成本分析
Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care.
作者信息
Williams Mark D, Braun Lee Ann, Cooper Liesl M, Johnston Joseph, Weiss Richard V, Qualy Rebecca L, Linde-Zwirble Walter
机构信息
Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, Indiana, USA.
出版信息
Crit Care. 2004 Oct;8(5):R291-8. doi: 10.1186/cc2893. Epub 2004 Jul 5.
INTRODUCTION
Infection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels.
METHODS
Data for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140-208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels.
RESULTS
There were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77-2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94-3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of 3.4 billion dollars per year.
CONCLUSION
Severe sepsis is a common, deadly, and costly complication in cancer patients.
引言
感染是癌症患者的一种重要并发症，常导致住院时间延长或使患者需要更长时间住院，还可导致急性器官功能障碍（严重脓毒症）并最终导致死亡。虽然已知癌症患者发生感染及后续并发症的风险较高，但目前尚无关于该问题严重程度的全国性评估。我们的目标是识别患有严重脓毒症的癌症患者，并将这些数据推算至全国范围。
方法
来自六个州（佛罗里达州、马萨诸塞州、新泽西州、纽约州、弗吉尼亚州和华盛顿州）的1999年所有住院病例数据，与美国人口普查数据、疾病控制中心生命统计数据以及美国国立癌症研究所的监测、流行病学和最终结果计划癌症患病率数据进行了合并。恶性肿瘤通过国际疾病分类（第九版，临床修订版）（ICD-9-CM）编码（140-208）进行识别，感染和急性器官衰竭则根据安格斯及其同事的研究从ICD-9-CM编码中识别。病例根据年龄进行识别，并推算至全国范围。
结果
共识别出606,176例癌症住院病例，其中29,795例（4.9%）患有严重脓毒症。根据美国人口的全国性估算，癌症患者每年发生126,209例严重脓毒症病例，即每1000名癌症患者每年发生16.4例。患有严重脓毒症的癌症患者的住院死亡率为37.8%。与总体人群相比，癌症患者住院的可能性要高得多（相对风险，2.77；95%置信区间，2.77-2.78），因严重脓毒症住院的可能性也更高（相对风险，3.96；95%置信区间，3.94-3.99）。总体而言，严重脓毒症占所有癌症死亡病例的8.5%（46,729例），每年造成的费用为34亿美元。
结论
严重脓毒症是癌症患者中常见、致命且代价高昂的并发症。
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