西班牙重症监护病房中严重脓毒症和脓毒性休克导致的死亡率下降：一项2005年和2011年的双队列研究。

Declining mortality due to severe sepsis and septic shock in Spanish intensive care units: A two-cohort study in 2005 and 2011.

作者信息

Sánchez B, Ferrer R, Suarez D, Romay E, Piacentini E, Gomà G, Martínez M L, Artigas A

机构信息

Intensive Care Department, Hospital Universitari Mútua Terrassa, PhD Programme, University of Barcelona, Barcelona, Spain.

Intensive Care Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias, Spain; Shock, organ dysfunction and Resuscitation Research Group (SODIR), VHIR, Barcelona, Spain.

出版信息

Med Intensiva. 2017 Jan-Feb;41(1):28-37. doi: 10.1016/j.medin.2016.09.004. Epub 2016 Oct 28.

DOI:10.1016/j.medin.2016.09.004

PMID:28029501

Abstract

OBJECTIVE

To analyze the evolution of sepsis-related mortality in Spanish Intensive Care Units (ICUs) following introduction of the Surviving Sepsis Campaign (SSC) guidelines and the relationship with sepsis process-of-care.

DESIGN

A prospective cohort study was carried out, with the inclusion of all consecutive patients presenting severe sepsis or septic shock admitted to 41 Spanish ICUs during two time periods: 2005 (Edusepsis study pre-intervention group) and 2011 (ABISS-Edusepsis study pre-intervention group).

SCOPE

Patients with severe sepsis or septic shock admitted to Spanish ICUs.

PATIENTS

All ICU admissions from the emergency department or wards and all ICU patients with a diagnosis of severe sepsis or septic shock. A total of 1348 patients were included: 630 in the 2005 group and 718 in the 2011 group.

INTERVENTION

None.

PRIMARY ENDPOINTS

ICU mortality, 28-day mortality and Hospital mortality, hospital length of stay, ICU length of stay and compliance with the resuscitation bundle.

RESULTS

Compliance with the resuscitation bundle was significantly greater in the 2011 group (5.7% vs. 9.9%; p=0.005), and was associated to lower mortality (OR 0.602 [0.365-0.994]; p=0.048). The 2011 group had lower absolute in-hospital mortality (44.0% vs. 32.6%; p=0.01), 28-day mortality (36.5% vs. 23.0%; p=0.01), and adjusted mortality (OR 0.64 [0.49-0.83], p=0.001).

CONCLUSIONS

Mortality related to severe sepsis or septic shock in Spain decreased between two patient cohorts in 2005 and 2011, and was attributable to earliness and improvement in sepsis care.

摘要

目的

分析西班牙重症监护病房（ICU）在引入《拯救脓毒症运动》（SSC）指南后脓毒症相关死亡率的变化情况以及与脓毒症治疗过程的关系。

设计

开展一项前瞻性队列研究，纳入在两个时间段入住41家西班牙ICU的所有连续出现严重脓毒症或脓毒性休克的患者：2005年（Edusepsis研究干预前组）和2011年（ABISS-Edusepsis研究干预前组）。

范围

入住西班牙ICU的严重脓毒症或脓毒性休克患者。

患者

所有从急诊科或病房转入ICU的患者以及所有诊断为严重脓毒症或脓毒性休克的ICU患者。共纳入1348例患者：2005年组630例，2011年组718例。

干预措施

无。

主要终点

ICU死亡率、28天死亡率和医院死亡率、住院时间、ICU住院时间以及对复苏集束方案的依从性。

结果

2011年组对复苏集束方案的依从性显著更高（5.7%对9.9%；p = 0.005），且与较低死亡率相关（比值比0.602 [0.365 - 0.994]；p = 0.048）。2011年组的绝对院内死亡率更低（44.0%对32.6%；p = 0.01），28天死亡率更低（36.5%对23.0%；p = 0.01），调整后死亡率更低（比值比0.64 [0.49 - 0.83]，p = 0.001）。