Blanco Jesús, Muriel-Bombín Arturo, Sagredo Víctor, Taboada Francisco, Gandía Francisco, Tamayo Luís, Collado Javier, García-Labattut Angel, Carriedo Demetrio, Valledor Manuel, De Frutos Martín, López María-Jesús, Caballero Ana, Guerra José, Alvarez Braulio, Mayo Agustín, Villar Jesús
Critical Care Department, Nuevo Hospital Universitario Río Hortega, Calle Dulzaina s/n, 47012 Valladolid, Spain.
Crit Care. 2008;12(6):R158. doi: 10.1186/cc7157. Epub 2008 Dec 17.
Sepsis is a leading cause of admission to non-cardiological intensive care units (ICUs) and the second leading cause of death among ICU patients. We present the first extensive dataset on the epidemiology of severe sepsis treated in ICUs in Spain.
We conducted a prospective, observational, multicentre cohort study, carried out over two 3-month periods in 2002. Our aims were to determine the incidence of severe sepsis among adults in ICUs in a specific area in Spain, to determine the early (48 h) ICU and hospital mortality rates, as well as factors associated with the risk of death.
A total of 4,317 patients were admitted and 2,619 patients were eligible for the study; 311 (11.9%) of these presented at least 1 episode of severe sepsis, and 324 (12.4%) episodes of severe sepsis were recorded. The estimated accumulated incidence for the population was 25 cases of severe sepsis attended in ICUs per 100,000 inhabitants per year. The mean logistic organ dysfunction system (LODS) upon admission was 6.3; the mean sepsis-related organ failure assessment (SOFA) score on the first day was 9.6. Two or more organ failures were present at diagnosis in 78.1% of the patients. A microbiological diagnosis of the infection was reached in 209 episodes of sepsis (64.5%) and the most common clinical diagnosis was pneumonia (42.8%). A total of 169 patients (54.3%) died in hospital, 150 (48.2%) of these in the ICU. The mortality in the first 48 h was 14.8%. Factors associated with early death were haematological failure and liver failure at diagnosis, acquisition of the infection prior to ICU admission, and total LODS score on admission. Factors associated with death in the hospital were age, chronic alcohol abuse, increased McCabe score, higher LODS on admission, DeltaSOFA 3-1 (defined as the difference in the total SOFA scores on day 3 and on day 1), and the difference of the area under the curve of the SOFA score throughout the first 15 days.
We found a high incidence of severe sepsis attended in the ICU and high ICU and hospital mortality rates. The high prevalence of multiple organ failure at diagnosis and the high mortality in the first 48 h suggests delays in diagnosis, in initial resuscitation, and/or in initiating appropriate antibiotic treatment.
脓毒症是入住非心脏重症监护病房（ICU）的主要原因，也是ICU患者死亡的第二大原因。我们呈现了西班牙ICU中治疗的严重脓毒症流行病学的首个广泛数据集。
我们在2002年进行了为期两个3个月的前瞻性、观察性、多中心队列研究。我们的目的是确定西班牙特定地区ICU中成人严重脓毒症的发病率，确定早期（48小时）ICU和医院死亡率，以及与死亡风险相关的因素。
共收治4317例患者，2619例符合研究条件；其中311例（11.9%）至少发生1次严重脓毒症，记录到324次（12.4%）严重脓毒症发作。该人群估计累积发病率为每年每10万居民中有25例在ICU接受治疗的严重脓毒症。入院时平均逻辑器官功能障碍系统（LODS）为6.3；第一天平均脓毒症相关器官功能衰竭评估（SOFA）评分为9.6。78.1%的患者在诊断时有两个或更多器官功能衰竭。209次脓毒症发作（64.5%）获得了感染的微生物学诊断，最常见的临床诊断是肺炎（42.8%）。共有169例患者（54.3%）在医院死亡，其中150例（48.2%）在ICU死亡。最初48小时内的死亡率为14.8%。与早期死亡相关的因素是诊断时血液系统衰竭和肝功能衰竭、ICU入院前获得感染以及入院时总LODS评分。与医院死亡相关的因素是年龄、慢性酒精滥用、麦凯布评分增加、入院时较高的LODS、DeltaSOFA 3 - 1（定义为第3天和第1天总SOFA评分的差异）以及前15天内SOFA评分曲线下面积的差异。
我们发现ICU中治疗的严重脓毒症发病率高，ICU和医院死亡率高。诊断时多器官功能衰竭的高患病率以及最初48小时内的高死亡率表明诊断、初始复苏和/或开始适当抗生素治疗存在延迟。
