School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
Crit Care Med. 2021 Feb 1;49(2):215-227. doi: 10.1097/CCM.0000000000004777.
To examine long-term mortality, resource utilization, and healthcare costs in sepsis patients compared to hospitalized nonsepsis controls.
Propensity-matched population-based cohort study using administrative data.
Ontario, Canada.
We identified a cohort of adults (≥ 18) admitted to hospitals in Ontario between April 1, 2012, and March 31, 2016, with follow-up to March 31, 2017. Sepsis patients were flagged using a validated International Classification of Diseases, 10th Revision-coded algorithm (Sepsis-2 definition), including cases with organ dysfunction (severe sepsis) and without (nonsevere). Remaining hospitalized patients were potential controls. Cases and controls were matched 1:1 on propensity score, age, sex, admission type, and admission date.
None.
Differences in mortality, rehospitalization, hospital length of stay, and healthcare costs were estimated, adjusting for remaining confounders using Cox regression and generalized estimating equations. Of 270,669 sepsis cases, 196,922 (73%) were successfully matched: 64,204 had severe and 132,718 nonsevere sepsis (infection without organ dysfunction). Over follow-up (median 2.0 yr), severe sepsis patients had higher mortality rates than controls (hazard ratio, 1.66; 95% CI, 1.63-1.68). Both severe and nonsevere sepsis patients had higher rehospitalization rates than controls (hazard ratio, 1.53; 95% CI, 1.50-1.55 and hazard ratio, 1.41; 95% CI, 1.40-1.43, respectively). Incremental costs (Canadian dollar 2018) in sepsis cases versus controls at 1-year were: $29,238 (95% CI, $28,568-$29,913) for severe and $9,475 (95% CI, $9,150-$9,727) for nonsevere sepsis.
Severe sepsis was associated with substantially higher long-term risk of death, rehospitalization, and healthcare costs, highlighting the need for effective postdischarge care for sepsis survivors.
与住院非脓毒症对照相比，检查脓毒症患者的长期死亡率、资源利用和医疗保健成本。
使用行政数据进行倾向匹配的基于人群的队列研究。
加拿大安大略省。
我们确定了一组 2012 年 4 月 1 日至 2016 年 3 月 31 日期间在安大略省住院的成年人（≥18 岁），随访至 2017 年 3 月 31 日。使用经过验证的国际疾病分类，第 10 修订版编码算法（脓毒症 2 定义）标记脓毒症患者，包括有器官功能障碍（严重脓毒症）和无器官功能障碍（非严重脓毒症）的病例。其余住院患者为潜在对照。病例和对照在倾向得分、年龄、性别、入院类型和入院日期上进行 1:1 匹配。
无。
使用 Cox 回归和广义估计方程，在调整其他混杂因素后，估计死亡率、再入院、住院时间和医疗保健成本的差异。在 270669 例脓毒症病例中，有 196922 例（73%）成功匹配：64204 例有严重脓毒症，132718 例非严重脓毒症（无器官功能障碍的感染）。在随访期间（中位数为 2.0 年），严重脓毒症患者的死亡率高于对照组（风险比，1.66；95%置信区间，1.63-1.68）。严重和非严重脓毒症患者的再入院率均高于对照组（风险比，1.53；95%置信区间，1.50-1.55 和风险比，1.41；95%置信区间，1.40-1.43）。与对照组相比，1 年内脓毒症病例的增量成本（2018 年加拿大元）为：严重脓毒症为 29238 美元（95%置信区间，28568-29913），非严重脓毒症为 9475 美元（95%置信区间，9150-9727）。
严重脓毒症与长期死亡、再入院和医疗保健成本的风险显著增加相关，突出了需要为脓毒症幸存者提供有效的出院后护理。
