在日本的重症监护病房中，严重脓毒症患者的夜间和非工作日与住院死亡率增加无关：JAAM FORECAST 研究。

Nighttime and non-business days are not associated with increased risk of in-hospital mortality in patients with severe sepsis in intensive care units in Japan: The JAAM FORECAST study.

机构信息

Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.

出版信息

J Crit Care. 2019 Aug;52:97-102. doi: 10.1016/j.jcrc.2019.04.021. Epub 2019 Apr 22.

DOI:10.1016/j.jcrc.2019.04.021

PMID:31035189

Abstract

PURPOSE

Hospital services are reduced during off-hour such as nighttime or weekend. Investigations of the off-hour effect on initial management and outcomes in sepsis are very limited. Thus, we tested the hypothesis that patients who were diagnosed with severe sepsis during the nighttime or on non-business days had altered initial management and clinical outcomes.

MATERIALS AND METHODS

Patients with severe sepsis from 59 ICUs between 2016 and 2017 were enrolled. The patients were categorized according to the diagnosis time or day and were then compared. The primary outcome was in-hospital mortality.

RESULTS

One thousand one hundred and forty-eight patients were analyzed; 769 daytime patients, vs. 379 nighttime patients, and 791 business day patients vs. 357 non-business day patients. There were no significant differences in in-hospital mortality between either daytime and nighttime (24.4% vs. 21.4%, P = .27; nighttime, adjusted odds ratio [OR] 1.17, 95% confidence interval [CI], 0.87-1.59, P = .30) or between business and non-business days (22.9% vs. 24.6%, P = .55; non-business day, adjusted OR 0.85, 95% CI 0.60-1.22, P = .85). Time to antibiotics was significantly shorter in the nighttime (114 vs. 89 min, P = .0055).

CONCLUSIONS

Nighttime and weekends were not associated with increased in-hospital mortality of severe sepsis.

摘要

目的

医院在非工作时间（如夜间或周末）会减少服务。关于夜间时段对脓毒症初始治疗和结局的影响的研究非常有限。因此，我们检验了这样一个假设，即在夜间或非工作日被诊断为严重脓毒症的患者，其初始治疗和临床结局会发生改变。

材料与方法

纳入了 2016 年至 2017 年间 59 个 ICU 中的 1148 名严重脓毒症患者。根据诊断时间或日期对患者进行分类，然后进行比较。主要结局是院内死亡率。

结果

共分析了 1148 名患者；769 名日间患者，379 名夜间患者；791 名工作日患者，357 名非工作日患者。夜间与日间（24.4%比 21.4%，P=0.27；夜间，调整后比值比 [OR] 1.17，95%置信区间 [CI] 0.87-1.59，P=0.30）或工作日与非工作日（22.9%比 24.6%，P=0.55；非工作日，调整后 OR 0.85，95%CI 0.60-1.22，P=0.85）之间的院内死亡率无显著差异。夜间开始使用抗生素的时间明显缩短（114 分钟比 89 分钟，P=0.0055）。