Department of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States; Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, United States.
Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Department of Neurology and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
J Crit Care. 2019 Apr;50:269-274. doi: 10.1016/j.jcrc.2019.01.005. Epub 2019 Jan 11.
The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically ill patients.
Retrospective cohort of consecutive patients, age ≥ 18 years admitted to intensive care units at the Mayo Clinic between January 2009 and October 2015. We compared patients who met old, new, both, or neither definition of sepsis shock. SMR were calculated using APACHE IV predicted mortality.
The initial cohort consisted of 16,720 patients who had suspicion of infection, 7463 required vasopressor support. The median (IQR) age was 65(54-75) years and 4167(55.8%) were male. Compared to patients with old definition, the patients with new definition had higher APACHE III score (median IQR); (73 (57-92) vs. 70 (56-89), p < .01); SOFA score; (6 (4-10) vs. 6 (4-9), p < .01), were older (70 (59-79) vs. 64 (54-74) years, p = .03). They also had higher hospital mortality, N (%) 71, (19.7%) vs. 40 (12.6%), p < .01) and a higher SMR (0.66 vs. 0.45, p < .01).
Compared to SEPSIS-II, SEPSIS-III definition of septic shock identifies patients further along disease trajectory with higher likelihood of poor outcome.
新提出的脓毒症休克定义在急诊和重症监护领域引起了广泛争议。我们旨在比较新（SEPSIS-III）与旧（SEPSIS-II）脓毒症休克定义在当代重症患者中的应用。
回顾性连续患者队列，年龄≥18 岁，于 2009 年 1 月至 2015 年 10 月期间入住梅奥诊所重症监护病房。我们比较了符合旧定义、新定义、两者兼有或均不符合的脓毒症休克患者。使用 APACHE IV 预测死亡率计算 SMR。
初始队列由 16720 例怀疑感染的患者组成，其中 7463 例需要升压支持。中位（IQR）年龄为 65（54-75）岁，4167（55.8%）为男性。与旧定义患者相比，新定义患者的 APACHE III 评分更高（中位数 IQR）；（73（57-92）vs.70（56-89），p<.01）；SOFA 评分更高；（6（4-10）vs.6（4-9），p<.01），年龄更大（70（59-79）vs.64（54-74）岁，p=.03）。他们的住院死亡率也更高，N（%）分别为 71（19.7%）和 40（12.6%），p<.01），SMR 更高（0.66 vs. 0.45，p<.01）。
与 SEPSIS-II 相比，SEPSIS-III 脓毒症休克定义可识别出疾病进展更严重、预后更差的患者。
