Ryoo Seung Mok, Kang Gu Hyun, Shin Tae Gun, Hwang Sung Yeon, Kim Kyuseok, Jo You Hwan, Park Yoo Seok, Choi Sung-Hyuk, Yoon Young Hoon, Kwon Woon Yong, Suh Gil Joon, Lim Tae Ho, Han Kap Su, Choi Han Sung, Chung Sung Phil, Kim Won Young
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Republic of Korea.
J Thorac Dis. 2018 Feb;10(2):845-853. doi: 10.21037/jtd.2018.01.96.
We compared the clinical characteristics and outcomes between the new definition of sepsis-3 septic shock and the definition previously used from 1991 until recently.
We conducted an observational study using a prospective, multi-center registry of septic shock from October 2015 to February 2017. Registry data were collected by 10 emergency departments (EDs) in tertiary hospitals that are members of the Korean Shock Society. Data on septic shock patients who met the previous septic shock definition were collected. The patients were divided into a sepsis-3 defined septic shock group, made up of those who met the new criteria for refractory hypotension with hyperlactatemia, and a group of those who met only the 1991 definition for septic shock. The primary outcome was 90-day mortality, and secondary outcomes were 28-day mortality and in-hospital mortality.
Of all 1,028 included patients, 574 (55.8%) met the septic shock criteria for sepsis-3, leaving 454 patients who met only the previous definition. Those who met the sepsis-3 criteria demonstrated higher comorbidity than those who met the previous definition (83.1% 75.3%, P<0.01), but there was no difference in infection focus. The sequential organ failure assessment (SOFA) (initial/maximal), the acute physiology, and the chronic health evaluation II scores were significantly higher in for those who met the sepsis-3 criteria [6.5±3.1 5.0±2.9, 9.3±3.8 6.6±3.4, and 20.0 (15.0-26.0) 15.0 (10.0-20.3), respectively; P<0.01]. The 90-day mortality was significantly higher in the sepsis-3 group (32.1% 23.3%; P<0.01). In-hospital and 28-day mortality were also higher in the sepsis-3 group (26.8% 17.1% and 25.1% 16.5%, respectively; P<0.01).
The new definition of septic shock successfully selected patients with greater severities and worse outcomes.
我们比较了脓毒症-3中感染性休克的新定义与1991年至最近所使用的旧定义之间的临床特征和结局。
我们进行了一项观察性研究，使用了2015年10月至2017年2月的感染性休克前瞻性多中心登记数据。登记数据由韩国休克协会成员的10家三级医院的急诊科收集。收集符合旧感染性休克定义的感染性休克患者的数据。患者被分为脓毒症-3定义的感染性休克组，该组由符合难治性低血压合并高乳酸血症新标准的患者组成，以及仅符合1991年感染性休克定义的患者组。主要结局是90天死亡率，次要结局是28天死亡率和住院死亡率。
在所有纳入的1028例患者中，574例（55.8%）符合脓毒症-3的感染性休克标准，其余454例仅符合旧定义。符合脓毒症-3标准的患者合并症比符合旧定义的患者更多（83.1%对75.3%，P<0.01），但感染灶无差异。符合脓毒症-3标准的患者序贯器官衰竭评估（SOFA）（初始/最高）、急性生理学和慢性健康状况评估II评分显著更高[分别为6.5±3.1对5.0±2.9、9.3±3.8对6.6±3.4、20.0（15.0 - 26.0）对15.0（10.0 - 20.3）；P<0.01]。脓毒症-3组的90天死亡率显著更高（32.1%对23.3%；P<0.01）。脓毒症-3组的住院死亡率和28天死亡率也更高（分别为26.8%对17.1%和25.1%对16.5%；P<0.01）。
感染性休克的新定义成功筛选出了病情更严重、结局更差的患者。
