德国儿童和新生儿脓毒症的流行病学：基于 2010 年至 2016 年全国诊断相关组数据的观察性研究结果。

Epidemiology of Sepsis Among Children and Neonates in Germany: Results From an Observational Study Based on Nationwide Diagnosis-Related Groups Data Between 2010 and 2016.

机构信息

Center for Sepsis Control and Care, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.

Center for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.

出版信息

Crit Care Med. 2021 Jul 1;49(7):1049-1057. doi: 10.1097/CCM.0000000000004919.

DOI:10.1097/CCM.0000000000004919

PMID:33729720

Abstract

OBJECTIVES

Worldwide, more than half of all sepsis cases occur in pediatric and adolescent patients, particularly in neonates. Previous population-based studies in these age groups often were limited to either neonatal or pediatric patients admitted to ICUs. We aimed to investigate the overall and age-specific incidence and case fatality of sepsis in children in Germany, a high-income country with a total population of 82 million.

DESIGN

Retrospective observational study based on the German Diagnosis-related Groups statistics of the years 2010-2016.

SETTING

All acute care hospitals in Germany except for prison and psychiatric hospitals.

PATIENTS

Pediatric patients less than or equal to 19 years with International Classification of Diseases, 10th Revision-coded sepsis, neonates with International Classification of Diseases, 10th Revision-coded neonatal sepsis.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We analyzed pediatric sepsis incidence in patients aged birth to less than or equal to 19 years old, case fatality, and underlying comorbidities, and neonatal sepsis incidence and case fatality within the neonatal period. We identified 14,635 pediatric sepsis cases among 15.4 million pediatric hospitalizations between 2010 and 2016 (= 0.1% of pediatric hospitalizations). The incidence of pediatric sepsis was 14 cases per 100,000 children between 0 and 19 years. Case fatality was 16.6% and decreased from 17.8% (2010) to 15.0% (2016). A total of 11.5% of hospital deaths in the age group 0-19 years were associated with pediatric sepsis. Sepsis incidence and case fatality were highest in children less than 1 year old and declined in older children and adolescents. Admissions with pediatric sepsis were more common in children with preexisting comorbidities compared with those without (0.52% vs 0.03% of pediatric admissions). In neonates, the incidence of neonatal sepsis was 1,006 cases per 100,000 live births. Case fatality was 3.9%. While 17.7% of very low birth weight infants had neonatal sepsis, only 2.1% of low birth weight and 0.6% of normal birth weight neonates were affected, respectively.

CONCLUSIONS

Sepsis is also in Germany a common and frequently fatal condition in pediatric patients, particularly among neonates and children with comorbidities.

摘要

目的

全世界超过一半的脓毒症病例发生在儿科和青少年患者中，尤其是新生儿。先前在这些年龄段进行的基于人群的研究通常仅限于 ICU 收治的新生儿或儿科患者。我们旨在研究德国儿童脓毒症的总体和年龄特异性发病率和病死率，德国是一个拥有 8200 万总人口的高收入国家。

设计

基于 2010-2016 年德国疾病相关组统计数据的回顾性观察性研究。

设置

德国除监狱和精神病院外的所有急性护理医院。

患者

年龄≤19 岁的伴有国际疾病分类，第 10 版编码脓毒症的儿科患者，伴有国际疾病分类，第 10 版编码新生儿脓毒症的新生儿。

干预措施

无。

测量和主要结果

我们分析了 2010 年至 2016 年间 1540 万儿科住院患者中年龄在出生至≤19 岁的儿科脓毒症患者的发病率、病死率和潜在合并症，以及新生儿期的新生儿脓毒症发病率和病死率。我们在 2010 年至 2016 年期间发现了 14635 例儿科脓毒症病例，占儿科住院患者的 0.1%（1540 万儿科住院患者）。0-19 岁儿童中儿科脓毒症的发病率为每 100,000 名儿童 14 例。病死率为 16.6%，从 2010 年的 17.8%下降到 2016 年的 15.0%。0-19 岁年龄组中，总共有 11.5%的医院死亡与儿科脓毒症有关。脓毒症发病率和病死率在<1 岁的儿童中最高，在较大的儿童和青少年中下降。与无合并症的儿童相比，伴有儿科脓毒症的儿童入院更为常见（儿科入院的 0.52% vs 0.03%）。在新生儿中，新生儿脓毒症的发病率为每 100,000 例活产儿 1006 例。病死率为 3.9%。极低出生体重儿中 17.7%患有新生儿脓毒症，而低出生体重儿中仅 2.1%，正常出生体重儿中 0.6%。