BMJ Glob Health. 2019 Feb 13;4(1):e001061. doi: 10.1136/bmjgh-2018-001061. eCollection 2019.
Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.
严重急性呼吸道感染（SARI）仍是全球各年龄组主要的死亡原因之一。在流行病学、临床管理及包括死亡率在内的结局方面，全球存在很大差异。我们于2016年1月1日至2017年8月31日在区域SARI高发季节期间，使用标准化数据收集工具，对全球各地的重症监护病房进行了短期观察性数据收集。对所有符合SARI纳入标准的入院患者收集为期1周的数据，并随访至出院。比较了各区域患者在微生物学、管理策略及结局方面的比例。根据世界银行的定义，按地理和经济因素对区域进行划分。从95家医院和23个国家收集了682例患者的数据。总体死亡率为9.5%。其中，21.7%为儿童，5岁以下儿童的病死率为1%。60岁以上患者的死亡率最高，为18.6%。病死率因地区而异：东亚和太平洋地区为10.2%（206例中的21例），撒哈拉以南非洲为4.3%（188例中的8例），南亚为0%（35例中的0例），北美为13.6%（184例中的25例），欧洲和中亚为14.3%（63例中的9例）。低收入和中低收入国家的合并死亡率为4%，而高收入国家为14%。在560例可获得完整数据的患者中，入院时计算的器官功能障碍评分显示，入院时的序贯器官衰竭评估（SOFA）评分与死亡率及住院时间显著相关。东亚和太平洋地区（48%）及北美地区（24%）的患者SOFA评分>12的比例最高。多变量分析表明，初始SOFA评分和年龄是医院生存的独立预测因素。SARI的重症监护管理及结局在各区域和收入分组中存在差异。重症监护病房的特定因素、地理位置和管理特征在预测最终结局方面不如基线严重程度可靠。这些发现可能有助于规划未来的疫情严重程度评估，但需要更具全球代表性的数据。
