脓毒症-2与脓毒症-3人群之间重症监护病房中脓毒症和脓毒性休克的流行病学：重症监护病房和急诊室中的脓毒症预后（SPICE-ICU）
Epidemiology of sepsis and septic shock in intensive care units between sepsis-2 and sepsis-3 populations: sepsis prognostication in intensive care unit and emergency room (SPICE-ICU).
作者信息
Abe Toshikazu, Yamakawa Kazuma, Ogura Hiroshi, Kushimoto Shigeki, Saitoh Daizoh, Fujishima Seitaro, Otomo Yasuhiro, Kotani Joji, Umemura Yutaka, Sakamoto Yuichiro, Sasaki Junichi, Shiino Yasukazu, Takeyama Naoshi, Tarui Takehiko, Shiraishi Shin-Ichiro, Tsuruta Ryosuke, Nakada Taka-Aki, Hifumi Toru, Hagiwara Akiyoshi, Ueyama Masashi, Yamashita Norio, Masuno Tomohiko, Ikeda Hiroto, Komori Akira, Iriyama Hiroki, Gando Satoshi
机构信息
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577 Japan.
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
出版信息
J Intensive Care. 2020 Jun 30;8:44. doi: 10.1186/s40560-020-00465-0. eCollection 2020.
BACKGROUND
Diagnosing sepsis remains difficult because it is not a single disease but a syndrome with various pathogen- and host factor-associated symptoms. Sepsis-3 was established to improve risk stratification among patients with infection based on organ failures, but it has been still controversial compared with previous definitions. Therefore, we aimed to describe characteristics of patients who met sepsis-2 (severe sepsis) and sepsis-3 definitions.
METHODS
This was a multicenter, prospective cohort study conducted by 22 intensive care units (ICUs) in Japan. Adult patients (≥ 16 years) with newly suspected infection from December 2017 to May 2018 were included. Those without infection at final diagnosis were excluded. Patient's characteristics and outcomes were described according to whether they met each definition or not.
RESULTS
In total, 618 patients with suspected infection were admitted to 22 ICUs during the study, of whom 530 (85.8%) met the sepsis-2 definition and 569 (92.1%) met the sepsis-3 definition. The two groups comprised different individuals, and 501 (81.1%) patients met both definitions. In-hospital mortality of study population was 19.1%. In-hospital mortality among patients with sepsis-2 and sepsis-3 patients was comparable (21.7% and 19.8%, respectively). Patients exclusively identified with sepsis-2 or sepsis-3 had a lower mortality (17.2% vs. 4.4%, respectively). No patients died if they did not meet any definitions. Patients who met sepsis-3 shock definition had higher in-hospital mortality than those who met sepsis-2 shock definition.
CONCLUSIONS
Most patients with infection admitted to ICU meet sepsis-2 and sepsis-3 criteria. However, in-hospital mortality did not occur if patients did not meet any criteria. Better criteria might be developed by better selection and combination of elements in both definitions.
TRIAL REGISTRATION
UMIN000027452.
背景
脓毒症的诊断仍然困难，因为它不是单一疾病，而是一种具有各种与病原体和宿主因素相关症状的综合征。脓毒症3.0的建立是为了基于器官功能衰竭改善感染患者的风险分层，但与之前的定义相比仍存在争议。因此，我们旨在描述符合脓毒症2.0（严重脓毒症）和脓毒症3.0定义的患者特征。
方法
这是一项由日本22个重症监护病房（ICU）进行的多中心前瞻性队列研究。纳入2017年12月至2018年5月新怀疑感染的成年患者（≥16岁）。最终诊断无感染的患者被排除。根据患者是否符合每个定义描述其特征和结局。
结果
研究期间，共有618例疑似感染患者入住22个ICU，其中530例（85.8%）符合脓毒症2.0定义，569例（92.1%）符合脓毒症3.0定义。两组由不同个体组成，501例（81.1%）患者符合两个定义。研究人群的院内死亡率为19.1%。脓毒症2.0和脓毒症3.0患者的院内死亡率相当（分别为21.7%和19.8%）。仅符合脓毒症2.0或脓毒症3.0的患者死亡率较低（分别为17.2%和4.4%）。不符合任何定义的患者无死亡。符合脓毒症3.0休克定义的患者比符合脓毒症2.0休克定义的患者院内死亡率更高。
结论
入住ICU的大多数感染患者符合脓毒症2.0和脓毒症3.0标准。然而，不符合任何标准的患者未发生院内死亡。通过更好地选择和组合两个定义中的要素，可能会制定出更好的标准。
试验注册号
UMIN000027452。
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