Center for Sepsis Control and Care (CSCC), Jena University Hospital; Institute of General Practice and Family Medicine, Jena University Hospital; Institute of General Practice, Charité-Universitätsmedizin Berlin; Institute of General Practice and Family Medicine, Munich University Hospital, Ludwig-Maximilians-Universität München; Center for Clinical Studies, Jena University Hospital; Clinic for Anaesthesiology and Intensive Care Medicine, Jena University Hospital; Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University; Institute of General Practice and Family Medicine, Ruhr-University Bochum; Institute of Medical Statistics, Computer Science and Data Sciences, Jena University Hospital.
Dtsch Arztebl Int. 2020 Nov 13;117(46):775-782. doi: 10.3238/arztebl.2020.0775.
There have not yet been any prospective registry studies in Germany with active investigation of the long-term survival of patients with sepsis.
The Jena Sepsis Registry (JSR) included all patients with a diagnosis of sepsis in the four intensive care units of Jena University Hospital from January 2011 to December 2015. Long-term survival 6-48 months after diagnosis was documented by asking the treating general practitioners. The survival times were studied with Kaplan-Meier estimators. Cox regressions were calculated to show associations between possible predictors and survival time.
1975 patients with sepsis or septic shock were included. The mean time of observation was 730 days. For 96.4% of the queries to the general practitioners, information on long-term survival was available. Mortality in the intensive care unit was 34% (95% confidence interval [32; 37]), and in-hospital mortality was 45% [42; 47]. The overall mortality six months after diagnosis was 59% [57; 62], the overall mortality 48 months after diagnosis was 74% [72; 78]. Predictors of shorter survival were age, nosocomial origin of sepsis, diabetes, cerebrovascular disease, duration of stay in the intensive care unit, and renal replacement therapy.
The nearly 75% mortality four years after diagnosis indicates that changes are needed both in the acute treatment of patients with sepsis and in their multi-sector long-term care. The applicability of these findings may be limited by their having been obtained in a single center.
德国目前还没有前瞻性登记研究对脓毒症患者的长期生存进行积极调查。
耶拿脓毒症登记研究(Jena Sepsis Registry,JSR)纳入了 2011 年 1 月至 2015 年 12 月期间耶拿大学医院 4 个重症监护病房中所有被诊断为脓毒症的患者。通过询问主治全科医生,记录诊断后 6-48 个月的长期生存情况。使用 Kaplan-Meier 估计器研究生存时间。计算 Cox 回归以显示可能的预测因素与生存时间之间的关联。
共纳入 1975 例脓毒症或感染性休克患者。观察时间的平均值为 730 天。对于向全科医生查询的 96.4%,可获得长期生存的信息。重症监护病房死亡率为 34%(95%置信区间[32;37]),住院死亡率为 45%[42;47]。诊断后 6 个月的总死亡率为 59%[57;62],诊断后 48 个月的总死亡率为 74%[72;78]。生存时间较短的预测因素包括年龄、医院获得性脓毒症、糖尿病、脑血管病、重症监护病房停留时间和肾脏替代治疗。
诊断后四年近 75%的死亡率表明,需要改变脓毒症患者的急性治疗和多部门长期护理方式。这些发现的适用性可能受到其在单个中心获得的限制。