维持性透析患者严重脓毒症的趋势及预后

Trends and Outcomes of Severe Sepsis in Patients on Maintenance Dialysis.

作者信息

Sakhuja Ankit, Nanchal Rahul S, Gupta Shipra, Amer Hatem, Kumar Gagan, Albright Robert C, Kashani Kianoush B

机构信息

Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Misc., USA.

出版信息

Am J Nephrol. 2016;43(2):97-103. doi: 10.1159/000444684. Epub 2016 Mar 10.

DOI:10.1159/000444684

PMID:26959243

Abstract

BACKGROUND

Though the incidence of severe sepsis is rising, there is a lack of contemporary information regarding the epidemiology and outcomes of severe sepsis in those on maintenance dialysis. The objectives of this study were to measure the incidence and outcomes of severe sepsis in those on maintenance dialysis.

METHODS

Using data from Nationwide Inpatient Sample database from 2005 to 2010, we included all hospitalizations of adults with severe sepsis based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Those on maintenance dialysis were identified by ICD-9-CM codes. We calculated incidence of severe sepsis and mortality. We used logistic regression to assess independent effect of maintenance dialysis status on mortality.

RESULTS

Of the estimated 5,000,152 hospitalizations with severe sepsis, 322,734 (6.4%) were on maintenance dialysis. The unadjusted incidence of severe sepsis was 145.4 per 1,000 in those on maintenance dialysis in comparison to 3.5 per 1,000 in the general population. Mortality was higher in those with severe sepsis (30.3 vs. 26.2%; p < 0.001). Maintenance dialysis is an independent predictor of death in those with severe sepsis (OR 1.26; 95% CI 1.23-1.29).

CONCLUSIONS

Hospitalizations with severe sepsis are more prevalent and associated with poor outcomes in those on maintenance dialysis.

摘要

背景

尽管严重脓毒症的发病率在上升，但缺乏关于维持性透析患者严重脓毒症的流行病学和转归的当代信息。本研究的目的是测定维持性透析患者严重脓毒症的发病率和转归。

方法

利用2005年至2010年全国住院患者样本数据库的数据，我们纳入了所有根据国际疾病分类第九版临床修订本（ICD-9-CM）编码诊断为严重脓毒症的成年住院患者。通过ICD-9-CM编码确定维持性透析患者。我们计算了严重脓毒症的发病率和死亡率。我们使用逻辑回归评估维持性透析状态对死亡率的独立影响。

结果

在估计的5,000,152例严重脓毒症住院患者中，322,734例（6.4%）接受维持性透析。维持性透析患者中严重脓毒症的未调整发病率为每1000人中有145.4例，而普通人群中为每1000人中有3.5例。严重脓毒症患者的死亡率更高（30.3%对26.2%；p<0.001）。维持性透析是严重脓毒症患者死亡的独立预测因素（比值比1.26；95%可信区间1.23-1.29）。