[重症监护病房脓毒症的流行病学研究：巴西脓毒症研究]

[An epidemiological study of sepsis in Intensive Care Units: Sepsis Brazil study].

作者信息

Sales Júnior João Andrade L, David Cid Marcos, Hatum Rodrigo, Souza Paulo César S P, Japiassú André, Pinheiro Cleovaldo T S, Friedman Gilberto, Silva Odin Barbosa da, Dias Mariza D Agostino, Koterba Edwin, Dias Fernando Suparregui, Piras Cláudio, Luiz Ronir Raggio

机构信息

Hospital de Clínicas de Niterói.

UTI, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro.

出版信息

Rev Bras Ter Intensiva. 2006 Mar;18(1):9-17.

PMID:25310321

Abstract

BACKGROUND AND OBJECTIVES

Sepsis represents the major cause of death in the ICUs all over the world. Many studies have shown an increasing incidence over time and only a slight reduce in mortality. Many new treatment strategies are arising and we should define the incidence and features of sepsis in Brazil.

METHODS

Prospective cohort study in sixty-five hospitals all over Brazil. The patients who were admitted or who developed sepsis during the month of September, 2003 were enrolled. They were followed until the 28th day and/or until their discharge. The diagnoses were made in accordance to the criteria proposed by ACCP/SCCM. It were evaluated demographic features, APACHE II score, SOFA (Sepsis-related Organ Failure Assessment) score, mortality, sources of infections, microbiology, morbidities and length of stay (LOS).

RESULTS

Seventy-five ICUs from all regions of Brazil took part in the study.3128 patients were identified and 521 (16.7%) filled the criteria of sepsis, severe sepsis or septic shock. Mean age was 61.7 (IQR 39-79), 293 (55.7%) were males, and the overall 28-day mortality rate was 46.6%. Average APACHE II score was 20 and SOFA score on the first day was 7 (IQR 4-10). SOFA score in the mortality group was higher on day 1 (8, IQR 5-11), and had increased on day 3 (9, IQR 6-12). The mortality rate for sepsis, severe sepsis and septic shock was 16.7%, 34.4% and 65.3%, respectively. The average LOS was 15 days (IQR 5-22). The two main sources of infection were the respiratory tract (69%) and the abdomen one (23.1%). Gram-negative bacilli were more prevalent (40.1%). Gram-positive cocci were identified in 32.8% and fungi infections in 5%. Mechanical ventilation was observed in 82.1% of the patients, Swan-Ganz catheter in 18.8%, vasopressors in 66.2% and hemotransfusion in 44.7%.

CONCLUSIONS

It was observed a high mortality of sepsis in the ICUs in Brazil. The high frequency of septic shock demonstrated a group at high risk of death. In order to have a better use of the resources and reduce in mortality during the next 5 years, it is very important to identify our specific features related to this syndrome.

摘要

背景与目的

脓毒症是全球重症监护病房（ICU）患者的主要死亡原因。许多研究表明，脓毒症的发病率随时间呈上升趋势，而死亡率仅略有下降。许多新的治疗策略不断涌现，我们应该明确巴西脓毒症的发病率及特征。

方法

在巴西各地65家医院开展前瞻性队列研究。纳入2003年9月期间入院或发生脓毒症的患者。对其进行随访直至第28天和/或出院。根据美国胸科医师学会（ACCP）/危重病医学会（SCCM）提出的标准进行诊断。评估患者的人口统计学特征、急性生理与慢性健康状况评分系统II（APACHE II）评分、脓毒症相关器官功能衰竭评估（SOFA）评分、死亡率、感染源、微生物学、合并症及住院时间（LOS）。

结果

巴西各地75个ICU参与了该研究。共识别出3128例患者，其中521例（16.7%）符合脓毒症、严重脓毒症或脓毒性休克的标准。平均年龄为61.7岁（四分位间距39 - 79岁），男性293例（55.7%），28天总体死亡率为46.6%。APACHE II评分平均为20分，第1天SOFA评分为7分（四分位间距4 - 10分）。死亡组第1天SOFA评分更高（8分，四分位间距5 - 11分），第3天有所升高（9分，四分位间距6 - 12分）。脓毒症、严重脓毒症和脓毒性休克的死亡率分别为16.7%、34.4%和65.3%。平均住院时间为15天（四分位间距5 - 22天）。两个主要感染源是呼吸道（69%）和腹部（23.1%）。革兰阴性杆菌更为常见（40.1%）。革兰阳性球菌占32.8%，真菌感染占5%。82.1%的患者接受了机械通气，18.8%使用了 Swan - Ganz导管，66.2%使用了血管活性药物，44.7%接受了输血。