Geier F, Greve Y, Popp S, Achterberg A, Glöckner E, Ziegler R, Heppner H J, Mang H, Christ M
Klinik für Notfall- und Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg.
Institut für Mikrobiologie und Hygiene, Klinikum Nürnberg.
Dtsch Med Wochenschr. 2014 Sep;139(38):1869-75. doi: 10.1055/s-0034-1387236. Epub 2014 Sep 9.
The in-hospital mortality of patients with severe sepsis and septic shock (ssss) is high. Of note, little is known about the health care situation of patients with sepsis in German emergency departments. The aim of the study was to analyze whether sepsis patients are treated according to current guidelines, to identify the treatment sites within the hospital and to evaluate the death rate of affected patients during index hospitalization.
In this single-centre, prospective and observational trial we analyzed consecutive patients with complaints of sepsis during August and September 2012.
During the study period 151 patients presented with complaints of sepsis (age 68.3 ± 18 years, 54.3% men, 45% with ssss, in-hospital mortality of the overall cohort: 14.6%). The Surviving Sepsis Campaign three hour bundle (lactate, blood cultures, broad spectrum antibiotics, and volume) was carried out in 54.2% of patients with ssss. In case of ssss, broad spectrum antibiotics were initiated in the emergency department in 85.4%. Patients with ssss were admitted to wards with usual care in 67.2%, in 32.8% they were admitted to an intensive or intermediate care unit. The in-hospital mortality of patients with ssss during their index hospitalization was 27.8%.
Despite the high in-hospital mortality rate, more than two thirds of the patients with ssss were admitted to wards with usual care. We call for action 1) to early identify affected patients, 2) to provide adequate risk stratification tools and 3) to realize an early disposition of patients to the appropriate care units.
严重脓毒症和脓毒性休克（ssss）患者的院内死亡率很高。值得注意的是，对于德国急诊科脓毒症患者的医疗状况知之甚少。本研究的目的是分析脓毒症患者是否按照当前指南进行治疗，确定医院内的治疗地点，并评估指数住院期间受影响患者的死亡率。
在这项单中心、前瞻性观察性试验中，我们分析了2012年8月和9月连续出现脓毒症症状的患者。
在研究期间，151例患者出现脓毒症症状（年龄68.3±18岁，男性占54.3%，45%为ssss，整个队列的院内死亡率：14.6%）。54.2%的ssss患者实施了脓毒症存活行动三小时集束治疗（乳酸、血培养、广谱抗生素和液体复苏）。对于ssss患者，85.4%在急诊科开始使用广谱抗生素。67.2%的ssss患者被收治到普通病房，32.8%被收治到重症监护病房或中级护理病房。ssss患者在指数住院期间的院内死亡率为27.8%。
尽管院内死亡率很高，但超过三分之二的ssss患者被收治到普通病房。我们呼吁采取行动：1）早期识别受影响的患者；2）提供适当的风险分层工具；3）尽早将患者转至适当的护理单元。
