Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.
Infect Dis Ther. 2015 Sep;4(3):321-35. doi: 10.1007/s40121-015-0086-6. Epub 2015 Sep 3.
Recent studies indicate that death certificate-based single-cause-of-death diagnoses can substantially underestimate the contribution of sepsis to mortality in the general population and among maternal decedents. There are no population-based data in the United States on the patterns of the contribution of sepsis to pregnancy-associated deaths.
We studied the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations with reported hospital death during 2001-2010. We then examined the annual reporting of sepsis, and that of other reported most common causes of maternal death, including hemorrhage, embolism, preeclampsia/eclampsia, cardiovascular conditions, cardiomyopathy, cerebrovascular accidents, and anesthesia complications. The annual rate of sepsis among decedents, its trend over time, and changes of its annual rank among other examined potential causes of maternal death were assessed.
There were 557 pregnancy-associated hospital deaths during study period. Sepsis was reported in 131 (23.5%) decedents. Sepsis has been increasingly reported among decedents, rising by 9.1%/year (P = 0.0025). The rank of sepsis, as compared to the other examined potential causes of maternal death rose from the 5th in 2001 to 1st since 2008. At the end of the last decade, sepsis has been reported in 28.1% of pregnancy-associated deaths. More than one potential cause of maternal death was reported in 39% of decedents.
Sepsis has become the most commonly reported potential cause of death among maternal decedents in the present cohort, noted in over 1 in 4 fatal hospitalizations by the end of the last decade. Although causality cannot be inferred from administrative data, given its known contribution to maternal death, it is likely that sepsis plays an increasing role in fatal maternal hospital outcomes. The prevalent co-reporting of multiple potential causes of maternal death in the present cohort underscores the complexity of determining the sources of evolving rise of maternal mortality.
最近的研究表明，基于死亡证明的单一死因诊断可能大大低估了败血症对普通人群和产妇死亡的贡献。在美国，没有关于败血症对与妊娠相关的死亡的贡献模式的基于人群的数据。
我们研究了德克萨斯州住院患者公共使用数据文件，以确定 2001 年至 2010 年期间报告有医院死亡的与妊娠相关的住院治疗。然后，我们检查了败血症的年度报告以及其他报告的最常见产妇死亡原因的报告，包括出血、栓塞、子痫/子痫、心血管疾病、心肌病、脑血管意外和麻醉并发症。评估了死者中败血症的年度发生率、随时间的趋势以及在其他检查的潜在产妇死亡原因中的年度排名变化。
研究期间有 557 例与妊娠相关的医院死亡。在 131 名死者（23.5%）中报告了败血症。败血症在死者中的报告比例逐年增加，每年增加 9.1%（P=0.0025）。与其他检查的潜在产妇死亡原因相比，败血症的排名从 2001 年的第 5 位上升到 2008 年以来的第 1 位。在上一个十年末，败血症在与妊娠相关的死亡中报告占 28.1%。在 39%的死者中报告了超过一种潜在的产妇死亡原因。
在本队列中，败血症已成为产妇死亡者中最常报告的潜在死因，在上一个十年末，超过 1/4 的致命性住院患者报告了败血症。尽管从行政数据中不能推断出因果关系，但鉴于败血症对产妇死亡的已知贡献，败血症很可能在致命性产妇医院结局中发挥越来越重要的作用。本队列中普遍报告多种潜在产妇死亡原因，突显了确定孕产妇死亡率上升原因的复杂性。
