Guidet Bertrand, Aegerter Philippe, Gauzit Remy, Meshaka Patrick, Dreyfuss Didier
Service de Réanimation Médicale, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
Chest. 2005 Mar;127(3):942-51. doi: 10.1378/chest.127.3.942.
To study the incidence and severity of organ dysfunction associated with sepsis.
Comprehensive review of prospectively collected data from intensive care patients hospitalized between 1997 and 2001.
Thirty-five ICUs in nonuniversity and university hospitals located in the Paris area.
All patients hospitalized in the ICU for > 24 h meeting the criteria for severe sepsis (SS), either with only one organ dysfunction present during the ICU stay (SS1; n = 5,675) or with at least two organ dysfunction present during the ICU stay (SS2; n = 12,598), were compared to all other patients hospitalized for > 24 h in the ICU over the same time period (n = 47,637).
None.
We collected information on demographic characteristics, type of admission, underlying disease, organ dysfunction, organ support, McCabe and Charlson-Deyo scores, simplified acute physiology score II, length of stay, and outcome. The incidence of SS was 27.7% (8.6% for SS1 and 19.1 for SS2). Compared with non-SS patients, those with SS were significantly older, were more frequently men, required organ support more frequently, had higher severity scores, and stayed longer in the ICU and hospital. Respiratory and cardiovascular dysfunction and fungal infection were strong independent risk factors for death in SS patients, with 5.64-fold, 4.35-fold, and 2.0-fold increased risks, respectively. SS2 is significantly different from SS1: older age, more surgical stays and admission from external transfer, greater number of organ supports, site of infection (less pulmonary and urinary tract infections, and more abdominal and cardiovascular infections), type of bacteria (more methicillin-resistant Staphylococcus aureus, Pseudomonas, and fungus), ICU length of stay (20.4 d vs 11.6 d), hospital length of stay (33 d vs 27.9 d), ICU mortality (42.7% vs 5.5%), and hospital mortality (49% vs 11.3%).
Our study identifies a subgroup of patients with an ICU stay > 24 h and SS with at least two organ dysfunctions. This group of patients requires special attention since their ICU mortality is > 40% and they occupy almost 40% of all ICU beds.
研究脓毒症相关器官功能障碍的发生率及严重程度。
对1997年至2001年期间入住重症监护病房的患者前瞻性收集的数据进行全面回顾。
位于巴黎地区的非大学医院和大学医院中的35个重症监护病房。
将入住重症监护病房超过24小时且符合严重脓毒症（SS）标准的所有患者进行比较，其中在重症监护病房住院期间仅出现一种器官功能障碍的患者（SS1；n = 5675）或至少出现两种器官功能障碍的患者（SS2；n = 12598），与同期在重症监护病房住院超过24小时的所有其他患者（n = 47637）进行比较。
无。
我们收集了有关人口统计学特征、入院类型、基础疾病、器官功能障碍、器官支持、麦凯布评分和查尔森 - 德约评分、简化急性生理学评分II、住院时间和结局的信息。SS的发生率为27.7%（SS1为8.6%，SS2为19.1%）。与非SS患者相比，SS患者年龄显著更大，男性更常见，更频繁需要器官支持，严重程度评分更高，在重症监护病房和医院的住院时间更长。呼吸和心血管功能障碍以及真菌感染是SS患者死亡的强烈独立危险因素，风险分别增加5.64倍、4.35倍和2.0倍。SS2与SS1有显著差异：年龄更大，手术住院和外部转入的情况更多，器官支持的数量更多，感染部位（肺部和尿路感染较少，腹部和心血管感染较多），细菌类型（耐甲氧西林金黄色葡萄球菌、铜绿假单胞菌和真菌更多），重症监护病房住院时间（20.4天对11.6天），医院住院时间（33天对27.9天），重症监护病房死亡率（42.7%对5.5%），以及医院死亡率（49%对11.3%）。
我们的研究确定了一组在重症监护病房住院超过24小时且患有至少两种器官功能障碍的严重脓毒症患者。这组患者需要特别关注，因为他们的重症监护病房死亡率超过40%，并且占用了几乎40%的重症监护病房床位。
