重症监护病房脓毒症和脓毒性休克的流行病学：使用国家重症监护数据库比较脓毒症-2 人群和脓毒症-3 人群。

Epidemiology of sepsis and septic shock in critical care units: comparison between sepsis-2 and sepsis-3 populations using a national critical care database.

机构信息

Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, 1st Floor, East Wing, St Thomas' Hospital, SE1 7EH, UK.

Division of Immunology, Infection and Inflammatory Diseases, Kings College London, SE1 9RT, UK.

出版信息

Br J Anaesth. 2017 Oct 1;119(4):626-636. doi: 10.1093/bja/aex234.

DOI:10.1093/bja/aex234

PMID:29121281

Abstract

BACKGROUND

New sepsis and septic shock definitions could change the epidemiology of sepsis because of differences in criteria. We therefore compared the sepsis populations identified by the old and new definitions.

METHODS

We used a high-quality, national, intensive care unit (ICU) database of 654 918 consecutive admissions to 189 adult ICUs in England, from January 2011 to December 2015. Primary outcome was acute hospital mortality. We compared old (Sepsis-2) and new (Sepsis-3) incidence, outcomes, trends in outcomes, and predictive validity of sepsis and septic shock populations.

RESULTS

From among 197 724 Sepsis-2 severe sepsis and 197 142 Sepsis-3 sepsis cases, we identified 153 257 Sepsis-2 septic shock and 39 262 Sepsis-3 septic shock cases. The extrapolated population incidence of Sepsis-3 sepsis and Sepsis-3 septic shock was 101.8 and 19.3 per 100 000 person-years, respectively, in 2015. Sepsis-2 severe sepsis and Sepsis-3 sepsis had similar incidence, similar mortality and showed significant risk-adjusted improvements in mortality over time. Sepsis-3 septic shock had a much higher Acute Physiology And Chronic Health Evaluation II (APACHE II) score, greater mortality and no risk-adjusted trends in mortality improvement compared with Sepsis-2 septic shock. ICU admissions identified either as Sepsis-3 sepsis or septic shock and as Sepsis-2 severe sepsis or septic shock had significantly greater risk-adjusted odds of death compared with non-sepsis admissions (P<0.001). The predictive validity was greatest for Sepsis-3 septic shock.

CONCLUSIONS

In an ICU database, compared with Sepsis-2, Sepsis-3 identifies a similar sepsis population with 92% overlap and much smaller septic shock population with improved predictive validity.

摘要

背景

新的脓毒症和脓毒性休克定义可能会因标准的不同而改变脓毒症的流行病学。因此，我们比较了旧定义和新定义所识别的脓毒症人群。

方法

我们使用了一个高质量的、全国性的、包含 189 个成人 ICU 的 ICU 数据库，该数据库包含了 2011 年 1 月至 2015 年 12 月期间英格兰 654918 例连续入住 ICU 的患者。主要结局是急性医院死亡率。我们比较了旧（Sepsis-2）和新（Sepsis-3）定义的发病率、结局、结局趋势以及脓毒症和脓毒性休克人群的预测有效性。

结果

在 197724 例 Sepsis-2 严重脓毒症和 197142 例 Sepsis-3 脓毒症患者中，我们确定了 153257 例 Sepsis-2 脓毒性休克和 39262 例 Sepsis-3 脓毒性休克患者。2015 年，Sepsis-3 脓毒症和 Sepsis-3 脓毒性休克的推测人群发病率分别为 101.8 和 19.3 例/10 万人年。Sepsis-2 严重脓毒症和 Sepsis-3 脓毒症的发病率相似，死亡率相似，且随着时间的推移，死亡率的风险调整后显著改善。与 Sepsis-2 脓毒性休克相比，Sepsis-3 脓毒性休克的急性生理学和慢性健康评估 II（APACHE II）评分更高，死亡率更高，且死亡率的风险调整后改善趋势无统计学意义。与非脓毒症患者相比，被诊断为 Sepsis-3 脓毒症或脓毒性休克以及 Sepsis-2 严重脓毒症或脓毒性休克的 ICU 患者死亡的风险调整后比值比显著更高（P<0.001）。预测有效性以 Sepsis-3 脓毒性休克最高。