Department of General Medicine, Juntendo University, Tokyo, Japan.
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
Sci Rep. 2020 Feb 19;10(1):2983. doi: 10.1038/s41598-020-59830-6.
The clinical implications of bacteremia among septic patients remain unclear, although a vast amount of data have been accumulated on sepsis. We aimed to compare the clinical characteristics and outcomes of severe sepsis patients with and without bacteremia. This secondary analysis of a multicenter, prospective cohort study included 59 intensive care units (ICUs) in Japan between January 2016 and March 2017. The study cohort comprised 1,184 adults (aged ≥ 16 years) who were admitted to an ICU with severe sepsis and diagnosed according to the Sepsis-2 criteria. Of 1,167 patients included in the analysis, 636 (54.5%) had bacteremia. Those with bacteremia had significantly higher rates of septic shock (66.4% vs. 58.9%, p = 0.01) and higher sepsis severity scores, including the Acute Physiology and Chronic Health Evaluation (APACHE) II and the Sequential Organ Failure Assessment (SOFA). No significant difference in in-hospital mortality was seen between patients with and without bacteremia (25.6% vs. 21.0%, p = 0.08). In conclusion, half of severe sepsis patients in ICUs have bacteremia. Although patients with bacteremia had more severe state, between-group differences in patient-centered outcomes, such as in-hospital mortality, have not been fully elucidated.
虽然已经积累了大量关于脓毒症的资料，但脓毒症患者菌血症的临床意义仍不清楚。我们旨在比较伴有和不伴有菌血症的严重脓毒症患者的临床特征和结局。这项多中心、前瞻性队列研究的二次分析纳入了日本 2016 年 1 月至 2017 年 3 月期间的 59 个重症监护病房（ICU）。研究队列包括 1184 名年龄≥16 岁、因严重脓毒症入住 ICU 并根据 Sepsis-2 标准诊断的成年人。在纳入分析的 1167 名患者中，有 636 名（54.5%）患有菌血症。菌血症患者发生感染性休克的比例明显更高（66.4% vs. 58.9%，p = 0.01），且脓毒症严重程度评分更高，包括急性生理学与慢性健康状况评分系统 II（APACHE II）和序贯器官衰竭评估（SOFA）。伴有和不伴有菌血症的患者院内死亡率无显著差异（25.6% vs. 21.0%，p = 0.08）。总之，ICU 中一半的严重脓毒症患者有菌血症。尽管菌血症患者的病情更严重，但两组患者的以患者为中心的结局（如院内死亡率）的差异尚未完全阐明。
