Reed Harrell Lester, Renton Sheila D, Hines Mark D
MultiCare Health System, Tacoma, WA
MultiCare Health System, Tacoma, WA.
Am J Med Qual. 2014 Jul-Aug;29(4):315-22. doi: 10.1177/1062860613496452. Epub 2013 Aug 12.
Sepsis is the 11th leading cause of death in the United States. The authors evaluated the dependence of all-cause in-hospital mortality on sepsis mortality. A retrospective observational cohort design and All Patient Refined Diagnosis Related Groups were used to evaluate 150 410 patients (>17 years of age) over 6 years. The hospital standardized mortality ratio (HSMR) decreased from 0.80 ± 0.04 to 0.65 ± 0.04 (observed/expected [O/E]). The HSMR was correlated with the standardized sepsis mortality ratio (SSMR), accounting for 61% of the variation (P < .0001). The mortality rate for sepsis declined from 14.54 ± 1.60% to 8.57 ± 1.88% (P < .002), and the SSMR decreased from 0.82 ± 0.09 to 0.48 ± 0.07 (O/E; P < .002). The months of sepsis mortality matched the months of hospital mortality for the lowest of each (odds ratio = 0.30, 95% confidence interval = 0.14-0.65; P < .003) and the highest of each (odds ratio = 1.47, 95% confidence interval = 1.18-1.84; P < .0007). Monitoring monthly mortality of sepsis can provide insight for timely intervention into variation of total in-hospital mortality.
脓毒症是美国第11大死因。作者评估了全因住院死亡率对脓毒症死亡率的依赖性。采用回顾性观察队列设计和所有患者精细诊断相关组对150410名年龄大于17岁的患者进行了为期6年的评估。医院标准化死亡率（HSMR）从0.80±0.04降至0.65±0.04（观察值/预期值[O/E]）。HSMR与标准化脓毒症死亡率（SSMR）相关，占变异的61%（P<.0001）。脓毒症死亡率从14.54±1.60%降至8.57±1.88%（P<.002），SSMR从0.82±0.09降至0.48±0.07（O/E；P<.002）。脓毒症死亡率最低的月份与医院死亡率最低的月份相匹配（比值比=0.30，95%置信区间=0.14-0.65；P<.003），最高的月份也相匹配（比值比=1.47，95%置信区间=1.18-1.84；P<.0007）。监测脓毒症的月度死亡率可为及时干预住院总死亡率的变化提供依据。
