Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany.
Intensive Care Med. 2018 Nov;44(11):1826-1835. doi: 10.1007/s00134-018-5377-4. Epub 2018 Oct 4.
Sepsis contributes considerably to global morbidity and mortality, while reasons for its increasing incidence remain unclear. We assessed risk adjusted secular trends in sepsis and infection epidemiology in Germany.
Retrospective cohort study using nationwide German hospital discharge data. We assessed incidence, outcomes and trends of hospital-treated sepsis and infections between 2010 and 2015. Sepsis was identified by explicit ICD-10 sepsis codes. As sensitivity analysis, results were compared with sepsis cases identified by implicit sepsis coding (combined infection and organ dysfunction codes).
Among 18 664 877 hospital admissions in 2015, 4 213 116 (22.6%) patients had at least one infection code. There were 320 198 patients that had explicit sepsis codes including 136 542 patients with severe sepsis and septic shock; 183 656 patients were coded as sepsis without organ dysfunction. For patients with explicitly coded sepsis (including severe sepsis), or with severe sepsis alone, mortality rates over the period 2010-2015 decreased from 26.6 to 23.5%, and from 47.8 to 41.7%, respectively.
Sepsis and infection remain significant causes of hospital admission and death in Germany. Sepsis-related mortality is higher and has declined to a lesser degree than in other high-income countries. Although infection rates steadily increased, the observed annual increase of sepsis cases seems to result, to a considerable degree, from improved coding of sepsis.
脓毒症导致了相当大的全球发病率和死亡率，但其发病率上升的原因仍不清楚。我们评估了德国脓毒症和感染流行病学的风险调整的时间趋势。
这是一项使用全国性德国医院出院数据的回顾性队列研究。我们评估了 2010 年至 2015 年期间医院治疗的脓毒症和感染的发生率、结局和趋势。脓毒症是通过明确的 ICD-10 脓毒症代码来识别的。作为敏感性分析，结果与通过隐式脓毒症编码（合并感染和器官功能障碍代码）识别的脓毒症病例进行了比较。
在 2015 年的 18664877 例住院患者中，有 4213116 例（22.6%）患者至少有一种感染代码。有 320198 例患者有明确的脓毒症代码，其中包括 136542 例严重脓毒症和脓毒性休克患者；183656 例患者被编码为无器官功能障碍的脓毒症。对于明确编码为脓毒症（包括严重脓毒症）或仅为严重脓毒症的患者，2010-2015 年期间的死亡率从 26.6%降至 23.5%，从 47.8%降至 41.7%。
脓毒症和感染仍然是德国住院和死亡的重要原因。脓毒症相关死亡率较高，且下降幅度小于其他高收入国家。尽管感染率稳步上升，但观察到的脓毒症病例的年增长率在相当程度上归因于脓毒症编码的改善。
