Kuye Ifedayo, Anand Vijay, Klompas Michael, Chan Christina, Kadri Sameer S, Rhee Chanu
Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Department of Medicine, University of California San Francisco, San Francisco, CA.
Crit Care Explor. 2021 Mar 16;3(3):e0373. doi: 10.1097/CCE.0000000000000373. eCollection 2021 Mar.
Some patients diagnosed with sepsis have very brief hospitalizations. Understanding the prevalence and clinical characteristics of these patients may provide insight into how sepsis diagnoses are being applied as well as the breadth of illnesses encompassed by current sepsis definitions.
Retrospective observational study.
One-hundred ten U.S. hospitals in the Cerner HealthFacts dataset (primary cohort) and four hospitals in Eastern Massachusetts (secondary cohort used for detailed medical record reviews).
Adults hospitalized from April 2016 to December 2017.
None.
We identified hospitalizations with 10th Edition codes for sepsis (including sepsis, septicemia, severe sepsis, and septic shock) and compared "short stay sepsis" patients (defined as discharge alive within 3 d) versus nonshort stay sepsis patients using detailed electronic health record data. In the Cerner cohort, 67,733 patients had sepsis discharge diagnosis codes, including 6,918 (10.2%) with short stays. Compared with nonshort stay sepsis patients, short stay patients were younger (median age 60 vs 67 yr) and had fewer comorbidities (median Elixhauser score 5 vs 13), lower rates of positive blood cultures (8.2% vs 24.1%), lower rates of ICU admission (6.2% vs 31.6%), and less frequently had severe sepsis/septic shock codes (13.5% vs 36.6%). Almost all short stay and nonshort stay sepsis patients met systemic inflammatory response syndrome criteria at admission (84.5% and 87.5%, respectively); 47.2% of those with short stays had Sequential Organ Failure Assessment scores of 2 or greater at admission versus 73.2% of those with longer stays. Findings were similar in the secondary four-hospital cohort. Medical record reviews demonstrated that physicians commonly diagnosed sepsis based on the presence of systemic inflammatory response syndrome criteria, elevated lactates, or positive blood cultures without concurrent organ dysfunction.
In this large U.S. cohort, one in 10 patients coded for sepsis were discharged alive within 3 days. Although most short stay patients met systemic inflammatory response syndrome criteria, they met Sepsis-3 criteria less than half the time. Our findings underscore the incomplete uptake of Sepsis-3 definitions, the breadth of illness severities encompassed by both traditional and new sepsis definitions, and the possibility that some patients with sepsis recover very rapidly.
一些被诊断为脓毒症的患者住院时间非常短。了解这些患者的患病率和临床特征，可能有助于深入了解脓毒症诊断的应用方式，以及当前脓毒症定义所涵盖的疾病范围。
回顾性观察研究。
Cerner HealthFacts数据集中的110家美国医院（主要队列）和马萨诸塞州东部的4家医院（用于详细病历审查的次要队列）。
2016年4月至2017年12月期间住院的成年人。
无。
我们确定了使用第10版脓毒症编码（包括脓毒症、败血症、严重脓毒症和脓毒性休克）的住院病例，并使用详细的电子健康记录数据，比较了“短期住院脓毒症”患者（定义为在3天内存活出院）和非短期住院脓毒症患者。在Cerner队列中，67733例患者有脓毒症出院诊断编码，其中6918例（10.2%）为短期住院。与非短期住院脓毒症患者相比，短期住院患者更年轻（中位年龄60岁对67岁），合并症更少（中位Elixhauser评分为5对13），血培养阳性率更低（8.2%对24.1%），ICU入住率更低（6.2%对31.6%），严重脓毒症/脓毒性休克编码的频率更低（13.5%对36.6%）。几乎所有短期和非短期住院脓毒症患者入院时均符合全身炎症反应综合征标准（分别为84.5%和87.5%）；短期住院患者中47.2%入院时序贯器官衰竭评估评分≥2，而长期住院患者中这一比例为73.2%。在四家医院的次要队列中，结果相似。病历审查表明，医生通常根据全身炎症反应综合征标准、乳酸升高或血培养阳性且无并发器官功能障碍来诊断脓毒症。
在这个美国大型队列中，每10例有脓毒症编码的患者中有1例在3天内存活出院。尽管大多数短期住院患者符合全身炎症反应综合征标准，但他们符合脓毒症-3标准的时间不到一半。我们的研究结果强调了脓毒症-3定义的应用不完整、传统和新脓毒症定义所涵盖的疾病严重程度范围，以及一些脓毒症患者可能恢复得非常快的可能性。
