Department of Emergency Medicine, 125573Chang Gung Memorial Hospital, Keelung.
Department of Emergency Medicine, 125573Chang Gung Memorial Hospital, Linkou.
J Intensive Care Med. 2020 Dec;35(12):1418-1425. doi: 10.1177/0885066619827270. Epub 2019 Jan 30.
Sepsis is a major cause of morbidity and mortality worldwide. With the advance of medical care, the mortality of sepsis has decreased in the past decades. Many treatments and diagnostic tools still lack supporting evidence. We conducted a retrospective population-based cohort study with propensity score matched subcohorts based on a prospectively collected national longitudinal health insurance database in Taiwan. Severe sepsis-associated hospital admissions from 2000 to 2011 based on codes of infections and acute organ dysfunction were identified. To compare the effectiveness of treatment and diagnostic tool, propensity scores were generated to match the comparable control groups. During the 12-year period, 33 375 patients and 50 465 hospitalizations of severe sepsis were identified. The age-standardized 28-day in-hospital mortality decreased significantly from 21% in 2008 to 15% in 2011 with increasingly implemented treatment and diagnostic tool. After propensity score matching, procalcitonin (odds ratio [OR]: 0.70, 95% confidence interval [95% CI]: 0.61-0.81) and lactate testing (OR: 0.90, 95% CI: 0.84-0.97, respectively), transfusion of packed red blood cell (OR: 0.60, 95% CI: 0.52-0.69), albumin (OR: 0.72, 95% CI: 0.55-0.93), balanced crystalloid (OR: 0.29, 95% CI: 0.20-0.41), and use of dopamine (OR: 0.44, 95% CI: 0.39-0.49) were found to be significantly associated with lower mortality rate. However, inconsistent findings need to be further validated.
脓毒症是全球发病率和死亡率的主要原因。随着医疗水平的提高，过去几十年脓毒症的死亡率有所下降。许多治疗方法和诊断工具仍然缺乏支持证据。我们在台湾进行了一项基于前瞻性收集的全国纵向医疗保险数据库的回顾性基于人群的队列研究，并进行了倾向评分匹配的亚组分析。根据感染和急性器官功能障碍的代码确定了 2000 年至 2011 年严重脓毒症相关的医院入院情况。为了比较治疗和诊断工具的效果，我们生成了倾向评分以匹配可比的对照组。在 12 年期间，确定了 33375 名患者和 50465 例严重脓毒症的住院治疗。2008 年标准化 28 天院内死亡率为 21%，2011 年降至 15%，这与越来越多的治疗和诊断工具的应用有关。经过倾向评分匹配后，降钙素原（比值比 [OR]：0.70，95%置信区间 [95%CI]：0.61-0.81）和乳酸检测（OR：0.90，95%CI：0.84-0.97）、输注浓缩红细胞（OR：0.60，95%CI：0.52-0.69）、白蛋白（OR：0.72，95%CI：0.55-0.93）、平衡晶体（OR：0.29，95%CI：0.20-0.41）和使用多巴胺（OR：0.44，95%CI：0.39-0.49）与较低的死亡率显著相关。然而，需要进一步验证不一致的发现。
