严重脓毒症幸存者的心血管事件风险。
Risk of cardiovascular events in survivors of severe sepsis.
机构信息
1 The Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, and.
出版信息
Am J Respir Crit Care Med. 2014 May 1;189(9):1065-74. doi: 10.1164/rccm.201307-1321OC.
RATIONALE
The risk of cardiovascular events after severe sepsis is not known, and these events may explain increased long-term mortality in survivors of severe sepsis.
OBJECTIVES
To determine whether survivors of severe sepsis hospitalization have high long-term risk of cardiovascular events. We examined whether higher risk is due to severe sepsis hospitalization or poor prehospitalization health status, and if the higher risk is also observed in patients hospitalized for infectious and noninfectious reasons, and in other critically ill patients.
METHODS
Unmatched and matched-cohort analyses of Medicare beneficiaries. For unmatched analysis, we compared patients with severe sepsis admitted to the intensive care unit (ICU) and survived hospitalization (n = 4,179) to unmatched population control subjects (n = 819,283). For matched analysis, we propensity-score-matched each patient with severe sepsis to four control subjects (population, hospitalized, non-severe sepsis ICU control subjects, and infection hospitalization). Primary outcome was 1-year incidence rate of hospitalization for cardiovascular events.
MEASUREMENTS AND MAIN RESULTS
Cardiovascular events were common among patients discharged alive after severe sepsis hospitalization (29.5%; 498.2 events/1,000 person-years). Survivors of severe sepsis had a 13-fold higher risk of cardiovascular events compared with unmatched control subjects (498.2 vs. 36 events/1,000 person-years; P < 0.0001), and a 1.9-fold higher risk compared with matched-population control subjects (P < 0.0001). Survivors of severe sepsis had 1.1-fold higher risk compared with matched hospitalized patients and infection hospitalizations (P = 0.002 and 0.001) and similar risk compared with matched-ICU control subjects.
CONCLUSIONS
Survivors of severe sepsis have high risk of cardiovascular events. The higher risk is mainly due to poor prehospitalization health status, and is also seen in a broader population of acutely ill patients.
背景
严重脓毒症后发生心血管事件的风险尚不清楚，这些事件可能解释了严重脓毒症幸存者长期死亡率增高的原因。
目的
确定严重脓毒症住院患者是否存在长期发生心血管事件的高风险。我们研究了较高风险是否归因于严重脓毒症住院治疗，或者是否归因于较差的院前健康状况，以及这种较高风险是否也存在于因感染和非感染原因住院的患者以及其他危重症患者中。
方法
使用医疗保险受益人的未匹配队列和匹配队列分析。对于未匹配分析，我们比较了入住重症监护病房（ICU）并存活出院的严重脓毒症患者（n = 4179）与未匹配的人群对照受试者（n = 819283）。对于匹配分析，我们采用倾向评分匹配了每位严重脓毒症患者与 4 位对照受试者（人群、住院、非严重脓毒症 ICU 对照受试者和感染性住院）。主要结局是 1 年内心血管事件住院的发生率。
测量和主要结果
存活出院的严重脓毒症患者中常见心血管事件（29.5%；1000 人年中有 498.2 例事件）。与未匹配对照受试者相比，严重脓毒症幸存者发生心血管事件的风险高 13 倍（498.2 比 36 例/1000 人年；P < 0.0001），与匹配人群对照受试者相比高 1.9 倍（P < 0.0001）。与匹配的住院患者和感染性住院患者相比，严重脓毒症幸存者的风险高 1.1 倍（P = 0.002 和 0.001），与匹配的 ICU 对照受试者的风险相似。
结论
严重脓毒症幸存者发生心血管事件的风险较高。较高的风险主要归因于较差的院前健康状况，并且在更广泛的急性病患者群体中也可见到。
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