Department of General Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
Crit Care. 2018 Nov 22;22(1):322. doi: 10.1186/s13054-018-2186-7.
Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan.
This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria.
In total, 1184 patients (median age 73 years, interquartile range (IQR) 64-81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6-11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21-26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12-46) days. Approximately 37% of the patients were discharged home after recovery.
Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan.
UMIN-CTR, UMIN000019742 . Registered on 16 November 2015.
脓毒症是发达国家死亡和长期残疾的主要原因。全面报告脓毒症的发病率、临床特征和不断发展的治疗方法非常重要。因此，本研究旨在评估日本严重脓毒症患者的特征、治疗方法和结局。
这是一项聚焦于急性呼吸窘迫综合征、脓毒症和创伤的急救护理中重点结局研究（FORECAST）的队列研究，该研究是 2016 年 1 月至 2017 年 3 月在 59 个重症监护病房（ICU）进行的一项多中心前瞻性队列研究。我们纳入了符合脓毒症 2 标准的严重脓毒症成年患者。
在研究期间，共有 1184 名（中位年龄 73 岁，四分位距 64-81）严重脓毒症患者入住 ICU。最常见的合并症是糖尿病（23%）。此外，约 63%的患者发生感染性休克。中位脓毒症相关器官衰竭评估（SOFA）评分为 9 分（四分位距 6-11）。最常见的感染部位是肺部（31%）。约 54%的患者有血培养阳性。整个 3 小时集束治疗的达标率、中心静脉压测量率和中心静脉血氧饱和度评估率分别为 64%、26%和 7%。多水平逻辑回归模型显示，封闭的 ICU 和非大学医院对整个 3 小时集束治疗的达标率更高。根据广义估计方程模型，年龄较大、合并多种疾病、疑似感染部位和 SOFA 评分增加与院内死亡率相关。严重脓毒症患者的住院时间为 24（12-46）天。大约 37%的患者在康复后出院回家。
我们的前瞻性研究表明，日本的脓毒症治疗以 3 小时集束治疗达标率高和中心静脉导管测量达标率低为特征。日本的院内死亡率与其他发达国家相当。考虑到日本 ICU 中老龄化、合并多种疾病的患者，只有三分之一的患者出院回家。
UMIN-CTR，UMIN000019742。于 2015 年 11 月 16 日注册。
