Wang Meiping, Jiang Li, Zhu Bo, Li Wen, Du Bin, Kang Yan, Weng Li, Qin Tiehe, Ma Xiaochun, Zhu Duming, Wang Yushan, Zhan Qingyuan, Duan Meili, Li Wenxiong, Sun Bing, Cao Xiangyuan, Ai Yuhang, Li Tong, Zhu Xi, Jia Jianguo, Zhou Jianxin, He Yan, Xi Xiuming
Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China.
Front Med (Lausanne). 2020 Dec 17;7:593808. doi: 10.3389/fmed.2020.593808. eCollection 2020.
Sepsis is a main cause of morbidity and mortality in critically ill patients. The epidemiology of sepsis in high-income countries is well-known, but information on sepsis in middle- or low-income countries is still deficient, especially in China. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically ill patients in tertiary hospitals in China. A multicenter prospective observational cohort study was performed with consecutively collected data from adults who stayed in any intensive care unit (ICU) for at least 24 h; data were collected from 1 January 2014 to 31 August 2015, and patients were followed until death or discharge from the hospital. A total of 4,910 patients were enrolled in the study. Of these, 2,086 (42.5%) presented with sepsis or septic shock on admission to the ICU or within the first 48 h after admission to the ICU. ICU mortality was higher in patients with sepsis (13.1%) and septic shock (39.0%) and varied according to geographical region. Acinetobacter, Pseudomonas, and Staphylococcus infections were associated with increased ICU mortality. In addition, age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, pre-existing cardiovascular diseases, malignant tumors, renal replacement therapy (RRT), and septic shock were independent risk factors for mortality in patients with sepsis. The prompt administration of antibiotics (OR 0.65, 95% CI 0.46-0.92) and 30 mL/kg of initial fluid resuscitation during the first 3 h (OR 0.43, 95% CI 0.30-0.63) improved the outcome in patients with septic shock. Sepsis was common and was associated with a high mortality rate in critically ill patients in tertiary hospitals in China. The prompt administration of antibiotics and 30 mL/kg fluid resuscitation decreased the risk of mortality.
脓毒症是危重症患者发病和死亡的主要原因。高收入国家脓毒症的流行病学情况已为人熟知，但关于中低收入国家脓毒症的信息仍然不足，在中国尤其如此。本研究的目的是探讨中国三级医院危重症患者脓毒症的患病率、特征、危险因素、治疗及转归。进行了一项多中心前瞻性观察队列研究，连续收集入住任何重症监护病房（ICU）至少24小时的成年患者的数据；数据收集时间为2014年1月1日至2015年8月31日，对患者进行随访直至死亡或出院。共有4910例患者纳入本研究。其中，2086例（42.5%）在入住ICU时或入住ICU后的前48小时内出现脓毒症或脓毒性休克。脓毒症患者（13.1%）和脓毒性休克患者（39.0%）的ICU死亡率较高，且因地理区域而异。不动杆菌、假单胞菌和葡萄球菌感染与ICU死亡率增加相关。此外，年龄、急性生理学与慢性健康状况评分系统II（APACHE II）评分、既往心血管疾病、恶性肿瘤、肾脏替代治疗（RRT）以及脓毒性休克是脓毒症患者死亡的独立危险因素。在最初3小时内及时给予抗生素（比值比[OR]0.65，95%置信区间[CI]0.46 - 0.92）和30 mL/kg的初始液体复苏（OR 0.43，95%CI 0.30 - 0.63）可改善脓毒性休克患者的转归。脓毒症在中国三级医院的危重症患者中很常见，且与高死亡率相关。及时给予抗生素和30 mL/kg液体复苏可降低死亡风险。
