Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, MO.
Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO.
Crit Care Med. 2021 Apr 1;49(4):e433-e443. doi: 10.1097/CCM.0000000000004875.
Assess the impact of heterogeneity among established sepsis criteria (Sepsis-1, Sepsis-3, Centers for Disease Control and Prevention Adult Sepsis Event, and Centers for Medicare and Medicaid severe sepsis core measure 1) through the comparison of corresponding sepsis cohorts.
Retrospective analysis of data extracted from electronic health record.
Single, tertiary-care center in St. Louis, MO.
Adult, nonsurgical inpatients admitted between January 1, 2012, and January 6, 2018.
None.
In the electronic health record data, 286,759 encounters met inclusion criteria across the study period. Application of established sepsis criteria yielded cohorts varying in prevalence: Centers for Disease Control and Prevention Adult Sepsis Event (4.4%), Centers for Medicare and Medicaid severe sepsis core measure 1 (4.8%), International Classification of Disease code (7.2%), Sepsis-3 (7.5%), and Sepsis-1 (11.3%). Between the two modern established criteria, Sepsis-3 (n = 21,550) and Centers for Disease Control and Prevention Adult Sepsis Event (n = 12,494), the size of the overlap was 7,763. The sepsis cohorts also varied in time from admission to sepsis onset (hr): Sepsis-1 (2.9), Sepsis-3 (4.1), Centers for Disease Control and Prevention Adult Sepsis Event (4.6), and Centers for Medicare and Medicaid severe sepsis core measure 1 (7.6); sepsis discharge International Classification of Disease code rate: Sepsis-1 (37.4%), Sepsis-3 (40.1%), Centers for Medicare and Medicaid severe sepsis core measure 1 (48.5%), and Centers for Disease Control and Prevention Adult Sepsis Event (54.5%); and inhospital mortality rate: Sepsis-1 (13.6%), Sepsis-3 (18.8%), International Classification of Disease code (20.4%), Centers for Medicare and Medicaid severe sepsis core measure 1 (22.5%), and Centers for Disease Control and Prevention Adult Sepsis Event (24.1%).
The application of commonly used sepsis definitions on a single population produced sepsis cohorts with low agreement, significantly different baseline demographics, and clinical outcomes.
通过比较相应的脓毒症队列，评估已确立的脓毒症标准（Sepsis-1、Sepsis-3、疾病控制与预防中心成人脓毒症事件和医疗保险和医疗补助严重脓毒症核心措施 1）之间异质性的影响。
从电子病历中提取数据的回顾性分析。
密苏里州圣路易斯的一家单一的三级保健中心。
2012 年 1 月 1 日至 2018 年 1 月 6 日期间入院的非手术成年住院患者。
无。
在电子病历数据中，研究期间共有 286759 次就诊符合纳入标准。应用已确立的脓毒症标准产生了患病率不同的队列：疾病控制与预防中心成人脓毒症事件（4.4%）、医疗保险和医疗补助严重脓毒症核心措施 1（4.8%）、国际疾病分类代码（7.2%）、Sepsis-3（7.5%）和 Sepsis-1（11.3%）。在这两个现代既定标准中，Sepsis-3（n=21550）和疾病控制与预防中心成人脓毒症事件（n=12494）之间的重叠大小为 7763。脓毒症队列在从入院到脓毒症发作的时间（小时）方面也存在差异：Sepsis-1（2.9）、Sepsis-3（4.1）、疾病控制与预防中心成人脓毒症事件（4.6）和医疗保险和医疗补助严重脓毒症核心措施 1（7.6）；脓毒症出院国际疾病分类代码率：Sepsis-1（37.4%）、Sepsis-3（40.1%）、医疗保险和医疗补助严重脓毒症核心措施 1（48.5%）和疾病控制与预防中心成人脓毒症事件（54.5%）；和院内死亡率：Sepsis-1（13.6%）、Sepsis-3（18.8%）、国际疾病分类代码（20.4%）、医疗保险和医疗补助严重脓毒症核心措施 1（22.5%）和疾病控制与预防中心成人脓毒症事件（24.1%）。
在单一人群中应用常用的脓毒症定义产生了脓毒症队列，这些队列具有低一致性、显著不同的基线人口统计学特征和临床结局。
