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急诊科的严重脓毒症——来自西印度群岛大学医院的一项观察性队列研究。

Severe sepsis in the emergency department - an observational cohort study from the university hospital of the West Indies.

作者信息

Edwards R, Hutson R, Johnson J, Sherwin R, Gordon-Strachan G, Frankson M, Levy P

机构信息

Division of Emergency Medicine, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica.

Departmnent of Emergency Medicine, Wayne State University School of Medicine, Michigan, USA.

出版信息

West Indian Med J. 2013 Mar;62(3):224-9.

PMID:24564044

Abstract

OBJECTIVE

To describe the incidence, treatment and outcomes of patients with severe sepsis and septic shock in a setting where early goal directed therapy (EGDT) is not routinely performed.

METHOD

An observational study of all adult patients admitted from the emergency department (ED) of the University Hospital of the West Indies (UHWI) with a diagnosis of severe sepsis and septic shock from July 5, 2007 to September 1, 2008 was conducted. Baseline parameters, treatment patterns and in-hospital outcomes were evaluated.

RESULTS

A total of 58 011 patients were seen and 762 (1.3%) had sepsis, 117 (15.4%) of whom were classified as severe sepsis or septic shock. Mean (SD) age was 59.2 (23.3) years and 49% were female. Medical history included hypertension (29%), diabetes mellitus (26%), stroke (8%), heart failure (6%) and HIV (6%). The most common sources of sepsis were pneumonia (67%) and urinary tract infection (46%). Median, interquartile range (IQR) time from triage to antibiotic administration was 126 (88, 220) minutes and antibiotics were given to 65.7% within three hours. Overall, organisms were sensitive to empirical antibiotics in 69%. Median (IQR) lactate was 5.3 (4.5, 7.5) mmol/L. Most patients (95%) were admitted to the ward; 1% went to the intensive care unit (ICU) and 2% died in the ED. Mean (SD) length of hospital stay was 9.5 (10.3) days. In-hospital mortality was 25% and survival correlated inversely with age (rpb = -0.25; p = 0.006).

CONCLUSION

Despite a lack of EGDT, sepsis treatment patterns were consistent with "best-practice" and mortality was lower than international comparators.

摘要

目的

描述在未常规实施早期目标导向治疗（EGDT）的情况下，严重脓毒症和脓毒性休克患者的发病率、治疗及转归。

方法

对2007年7月5日至2008年9月1日从西印度群岛大学医院急诊科（ED）收治的所有诊断为严重脓毒症和脓毒性休克的成年患者进行一项观察性研究。评估基线参数、治疗模式及住院期间转归。

结果

共诊治58011例患者，其中762例（1.3%）患有脓毒症，117例（15.4%）被归类为严重脓毒症或脓毒性休克。平均（标准差）年龄为59.2（23.3）岁，49%为女性。病史包括高血压（29%）、糖尿病（26%）、中风（8%）、心力衰竭（6%）和HIV（6%）。脓毒症最常见的来源是肺炎（67%）和尿路感染（46%）。从分诊到使用抗生素的中位时间、四分位间距（IQR）为126（88，220）分钟，65.7%的患者在3小时内使用了抗生素。总体而言，69%的病原体对经验性抗生素敏感。中位（IQR）乳酸水平为5.3（4.5，7.5）mmol/L。大多数患者（95%）被收入病房；1%入住重症监护病房（ICU），2%在急诊科死亡。平均（标准差）住院时间为9.5（10.3）天。住院死亡率为25%，生存率与年龄呈负相关（rpb = -0.25；p = 0.006）。