既定的预后因素能否解释全球 ICU 脓毒症患者死亡率的差异？

Do established prognostic factors explain the different mortality rates in ICU septic patients around the world?

机构信息

Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.

出版信息

Minerva Anestesiol. 2012 Nov;78(11):1215-25. Epub 2012 Jun 28.

Abstract

BACKGROUND

The aim of this paper was to clarify if previously established prognostic factors explain the different mortality rates observed in ICU septic patients around the world.

METHODS

This is a sub-study from the PROGRESS study, which was an international, prospective, observational registry of ICU patients with severe sepsis. For this study we included 10930 patients from 24 countries that enrolled more than 100 patients in the PROGRESS. The effect of potential prognostic factors on in-hospital mortality was examined using univariate and multivariate logistic regression. The complete set of data was available for 7022 patients, who were considered in the multivariate analysis. Countries were classified according to country income, development status, and in-hospital mortality terciles. The relationship between countries' characteristics and in-hospital mortality was evaluated using linear regression.

RESULTS

Mean in-hospital mortality was 49.2%. Severe sepsis in-hospital mortality varied widely in different countries, ranging from 30.6% in New Zealand to 80.4% in Algeria. Classification as developed or developing country was not associated with in-hospital mortality (P=0.16), nor were levels of gross national product per capita (P=0.15). Patients in the group of countries with higher in-hospital mortality had a crude OR for in-hospital death of 2.8 (95% CI 2.5-3.1) in comparison to those in the lower risk group. After adjustments were made for all other independent variables, the OR changed to 2.9 (95% CI 2.5-3.3).

CONCLUSION

Severe sepsis mortality varies widely in different countries. All known markers of disease severity and prognosis do not fully explain the international differences in mortality. Country income does not explain this disparity either. Further studies should be developed to verify if other organizational or structural factors account for disparities in patient care and outcomes.

摘要

背景

本文旨在阐明先前确定的预后因素是否可以解释世界各地 ICU 脓毒症患者观察到的不同死亡率。

方法

这是 PROGRESS 研究的子研究，该研究是一项针对 ICU 严重脓毒症患者的国际、前瞻性、观察性登记研究。在这项研究中，我们纳入了来自 24 个国家的 10930 名患者，这些国家在 PROGRESS 中招募了超过 100 名患者。使用单变量和多变量逻辑回归检查潜在预后因素对住院死亡率的影响。对于多变量分析，我们考虑了完整数据集的 7022 名患者。根据国家收入、发展状况和住院死亡率三分位数对国家进行分类。使用线性回归评估国家特征与住院死亡率之间的关系。

结果

平均住院死亡率为 49.2%。不同国家严重脓毒症的住院死亡率差异很大，从新西兰的 30.6%到阿尔及利亚的 80.4%。发达国家和发展中国家的分类与住院死亡率无关（P=0.16），人均国民生产总值水平也无关（P=0.15）。与低风险组相比，住院死亡率较高的国家组患者的住院死亡粗比值比（OR）为 2.8（95%CI 2.5-3.1）。在对所有其他独立变量进行调整后，OR 变为 2.9（95%CI 2.5-3.3）。