Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI.
Chest. 2011 Nov;140(5):1223-1231. doi: 10.1378/chest.11-0352. Epub 2011 Aug 18.
Severe sepsis is common and often fatal. The expanding armamentarium of evidence-based therapies has improved the outcomes of persons with this disease. However, the existing national estimates of the frequency and outcomes of severe sepsis were made before many of the recent therapeutic advances. Therefore, it is important to study the outcomes of this disease in an aging US population with rising comorbidities.
We used the Healthcare Costs and Utilization Project's Nationwide Inpatient Sample (NIS) to estimate the frequency and outcomes of severe sepsis hospitalizations between 2000 and 2007. We identified hospitalizations for severe sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating the presence of sepsis and organ system failure. Using weights from NIS, we estimated the number of hospitalizations for severe sepsis in each year. We combined these with census data to determine the number of severe sepsis hospitalizations per 100,000 persons. We used discharge status to identify in-hospital mortality and compared mortality rates in 2000 with those in 2007 after adjusting for demographics, number of organ systems failing, and presence of comorbid conditions.
The number of severe sepsis hospitalizations per 100,000 persons increased from 143 in 2000 to 343 in 2007. The mean number of organ system failures during admission increased from 1.6 to 1.9 (P < .001). The mean length of hospital stay decreased from 17.3 to 14.9 days. The mortality rate decreased from 39% to 27%. However, more admissions ended with discharge to a long-term care facility in 2007 than in 2000 (35% vs 27%, P < .001).
An increasing number of admissions for severe sepsis combined with declining mortality rates contribute to more individuals surviving to hospital discharge. Importantly, this leads to more survivors being discharged to skilled nursing facilities and home with in-home care. Increased attention to this phenomenon is warranted.
严重脓毒症很常见，且通常致命。循证治疗方法的不断扩展改善了此类疾病患者的预后。然而，最近的许多治疗进展之前，已有关于严重脓毒症的发生频率和结局的现有全国估计。因此，在患有不断增加的合并症的美国老龄化人群中研究这种疾病的结局非常重要。
我们使用医疗保健费用和利用项目的全国住院患者样本（NIS）来估计 2000 年至 2007 年严重脓毒症住院的频率和结局。我们使用国际疾病分类，第九修订版，临床修正代码来确定严重脓毒症住院患者，这些代码表明存在脓毒症和器官系统衰竭。我们使用 NIS 的权重来估计每年严重脓毒症住院的数量。我们将这些数量与人口普查数据结合起来，以确定每 100,000 人中严重脓毒症住院的数量。我们使用出院状态来确定院内死亡率，并在调整人口统计学，失败的器官系统数量和合并症存在情况后，比较 2000 年和 2007 年的死亡率。
每 100,000 人中严重脓毒症住院的人数从 2000 年的 143 人增加到 2007 年的 343 人。住院期间器官系统衰竭的平均数量从 1.6 增加到 1.9（P <.001）。住院时间的平均长度从 17.3 天减少到 14.9 天。死亡率从 39%下降到 27%。然而，2007 年比 2000 年更多的入院以长期护理机构出院（35%对 27%，P <.001）。
严重脓毒症入院人数的增加，加上死亡率的下降，导致更多的人存活至出院。重要的是，这导致更多的幸存者被送往熟练护理机构和家庭，接受家庭护理。对此现象的关注增加是必要的。
