Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany.
Institut für Versorgungsforschung der Knappschaft, Knappschaft, Bochum, Germany.
PLoS One. 2020 Feb 12;15(2):e0228952. doi: 10.1371/journal.pone.0228952. eCollection 2020.
Patients with severe infections and especially sepsis have a high in-hospital mortality, but even hospital survivors face long-term sequelae, decreased health-related quality of life, and high risk of death, suggesting a great need for specialized aftercare. However, data regarding a potential benefit of post-discharge rehabilitation in these patients are scarce. In this retrospective matched cohort study the claim data of a large German statutory health care insurer was analyzed. 83,974 hospital survivors having suffered from septic shock, sepsis, and severe infections within the years 2009-2016 were identified using an ICD abstraction strategy closely matched to the current Sepsis-3 definition. Cases were analyzed and compared with their matched pairs to determine their 5-year mortality and the impact of post-discharge rehabilitation. Five years after hospital discharge, mortality of initial hospital survivors were still increased after septic shock (HRadj 2.03, 95%-CI 1.87 to 2.19; P<0.001), sepsis (HRadj 1.73, 95%-CI 1.71 to 1.76; P<0.001), and also in survivors of severe infections without organ dysfunction (HRadj 1.70, 95%-CI 1.65 to 1.74; P<0.001) compared to matched controls without infectious diseases. Strikingly, patients treated in rehabilitation facilities showed a significantly improved 5-year survival after suffering from sepsis or septic shock (HRadj 0.81, 95%-CI 0.77 to 0.85; P<0.001) as well as severe infections without organ dysfunction (HRadj 0.81, 95%-CI 0.73 to 0.90; P<0.001) compared to matched patients discharged to home or self-care. Long-term mortality and morbidity of hospital survivors are markedly increased after septic shock, sepsis and severe infections without organ dysfunction, but best 5-year survival was recorded in patients discharged to a rehabilitation facility in all three groups. Thus, our data suggest that specialized aftercare programs may help to improve long-term outcome in these patients and warrants more vigilance in future investigations.
患有严重感染，尤其是败血症的患者住院死亡率较高，但即使是医院幸存者也面临长期后遗症、健康相关生活质量下降和高死亡率的风险，这表明他们非常需要专门的康复治疗。然而，关于这些患者出院后康复治疗潜在益处的数据却很少。在这项回顾性匹配队列研究中，对一家大型德国法定健康保险公司的索赔数据进行了分析。使用与当前败血症-3 定义密切匹配的 ICD 摘要策略，确定了 2009 年至 2016 年期间患有败血症性休克、败血症和严重感染的 83974 名医院幸存者。对病例进行了分析，并与匹配的对照组进行了比较，以确定他们的 5 年死亡率和出院后康复的影响。出院后 5 年，败血症性休克（调整后的 HR 为 2.03，95%CI 为 1.87 至 2.19；P<0.001）、败血症（调整后的 HR 为 1.73，95%CI 为 1.71 至 1.76；P<0.001）和无器官功能障碍的严重感染幸存者（调整后的 HR 为 1.70，95%CI 为 1.65 至 1.74；P<0.001）的死亡率仍高于无传染病的匹配对照组。引人注目的是，与出院回家或自我护理的匹配患者相比，在康复设施中接受治疗的患者在患有败血症或败血症性休克（调整后的 HR 为 0.81，95%CI 为 0.77 至 0.85；P<0.001）以及无器官功能障碍的严重感染（调整后的 HR 为 0.81，95%CI 为 0.73 至 0.90；P<0.001）后，5 年生存率显著提高。因此，我们的数据表明，专门的康复治疗方案可能有助于改善这些患者的长期预后，未来的研究需要更加警惕。
