Oud Lavi
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX 79763 USA.
J Intensive Care. 2020 Jan 6;8:3. doi: 10.1186/s40560-019-0424-y. eCollection 2020.
Sepsis is the most common cause of premature death among patients with systemic lupus erythematosus (SLE) aged ≤ 50 years in the United States, and infection is the most common cause of admission to the ICU among SLE patients. However, there are no population-level data on the patterns of the demand for critical care services among hospitalized septic patients with SLE or the outcomes of those admitted to the ICU.
We performed a retrospective cohort study, using the Texas Inpatient Public Use Data File, to identify SLE hospitalizations aged ≥ 18 years and the subgroups with sepsis and ICU admission during 2009-2014. The patterns of ICU admission among septic hospitalizations were examined. Logistic regression modeling was used to identify predictors of short-term mortality (defined as hospital death or discharge to hospice) among ICU admissions with sepsis and to estimate the risk-adjusted short-term mortality among ICU admissions with and without sepsis.
Among 94,338 SLE hospitalizations, 17,037 (18.1%) had sepsis and 9409 (55.2%) of the latter were admitted to the ICU. Sepsis accounted for 51.5% of the growth in volume of ICU admissions among SLE hospitalizations during the study period. Among ICU admissions with sepsis, 25.3% were aged ≥ 65 years, 88.6% were female, and 64.4% were non-white minorities. The odds of short-term mortality among septic ICU admissions were increased among those lacking health insurance (adjusted odds ratio 1.40 [95% confidence interval 1.07-1.84]), while being unaffected by gender and race/ethnicity, and remaining unchanged over the study period. On adjusted analyses among ICU admissions, the short-term mortality among those with and without sepsis was 13% (95% CI 12.6-13.3) and 2.7% (95% CI 2.6-2.8), respectively. Sepsis was associated with 63.6% of all short-term mortality events.
Sepsis is a major, incremental driver of the demand for critical care services among SLE hospitalizations. Despite its relatively low mortality, sepsis was associated with most of the short-term deaths among ICU patients with SLE.
在美国，脓毒症是50岁及以下系统性红斑狼疮（SLE）患者过早死亡的最常见原因，而感染是SLE患者入住重症监护病房（ICU）的最常见原因。然而，对于住院的脓毒症SLE患者的重症监护服务需求模式或入住ICU患者的结局，尚无人群水平的数据。
我们利用德克萨斯州住院患者公共使用数据文件进行了一项回顾性队列研究，以确定2009年至2014年期间年龄≥18岁的SLE住院患者以及发生脓毒症和入住ICU的亚组。研究了脓毒症住院患者的ICU入住模式。采用逻辑回归模型确定脓毒症ICU入住患者短期死亡率（定义为医院死亡或转至临终关怀机构）的预测因素，并估计有脓毒症和无脓毒症的ICU入住患者经风险调整后的短期死亡率。
在94338例SLE住院患者中，17037例（18.1%）发生脓毒症，其中9409例（55.2%）入住ICU。在研究期间，脓毒症占SLE住院患者中ICU入住量增长的51.5%。在脓毒症ICU入住患者中，25.3%年龄≥65岁，88.6%为女性，64.4%为非白人少数族裔。缺乏医疗保险的脓毒症ICU入住患者短期死亡几率增加（调整后的优势比为1.40[95%置信区间为1.07-1.84]），而不受性别和种族/民族影响，且在研究期间保持不变。在ICU入住患者的调整分析中，有脓毒症和无脓毒症患者的短期死亡率分别为13%（95%CI 12.6-13.3）和2.7%（95%CI 2.6-2.8）。脓毒症与所有短期死亡事件的63.6%相关。
脓毒症是SLE住院患者重症监护服务需求的主要增量驱动因素。尽管其死亡率相对较低，但脓毒症与SLE的ICU患者中的大多数短期死亡相关。
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