Department of Anaesthesia and Intensive Care, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Acta Anaesthesiol Scand. 2022 Apr;66(4):497-506. doi: 10.1111/aas.14026. Epub 2022 Jan 17.
Registry-based studies have shown increasing incidence of sepsis and declining mortality rates in recent years, but are inherently at risk of bias. The objectives of this study were to describe 11-year trends in the incidence, treatment and outcome of sepsis using clinical criteria with chart review.
This was a retrospective, observational study. All adult admissions to Icelandic ICUs during years 2006, 2008, 2010, 2012, 2014, and 2016 were screened for severe sepsis or septic shock by ACCP/SCCM criteria (sepsis-2). Incidence, patient characteristics, treatment and outcome were compared across the study years.
During the six study years, 9166 patients were admitted to Icelandic ICUs, 971 (10.6%) because of severe sepsis or septic shock. The crude incidence of sepsis requiring admission to ICU remained stable between 0.55 and 0.75 per 1000 inhabitants. No statistically significant trends were observed over time in median patient age (67 years), APACHE II score (21), SOFA score (8) or Charlson Comorbidity Index (4). The time to antibiotic administration (median 1.8 h) in the emergency departments was stable over the study period but the time to lactate measurements decreased from 4.1 h in 2006 to 1.2 h in 2016, p < .001. The 28-day mortality was 25% and 1-year mortality 41%, both with no observed change with time.
In a nationwide cohort, diagnosed with clinical criteria, the incidence of sepsis requiring intensive care did not change over an 11-year period. Mortality remained stable and only minimal changes were observed in initial resuscitation in the emergency departments.
基于登记的研究表明，近年来脓毒症的发病率不断上升，死亡率不断下降，但这些研究本身存在偏倚风险。本研究的目的是使用临床标准并通过病历回顾来描述 11 年来脓毒症的发病率、治疗和结局变化趋势。
这是一项回顾性、观察性研究。通过 ACCP/SCCM 标准（sepsis-2）筛选 2006 年、2008 年、2010 年、2012 年、2014 年和 2016 年入住冰岛 ICU 的所有成年患者是否患有严重脓毒症或脓毒性休克。比较了研究期间的发病率、患者特征、治疗和结局。
在 6 年的研究期间，9166 名患者入住冰岛 ICU，其中 971 名（10.6%）因严重脓毒症或脓毒性休克而入住。需要入住 ICU 的脓毒症发病率在 0.55 至 0.75 例/1000 居民之间保持稳定。患者年龄（中位数 67 岁）、APACHE II 评分（21 分）、SOFA 评分（8 分）或 Charlson 合并症指数（4 分）在整个研究期间无明显变化趋势。在急诊科开始使用抗生素的时间（中位数 1.8 小时）在研究期间保持稳定，但测量乳酸的时间从 2006 年的 4.1 小时减少到 2016 年的 1.2 小时，p <.001。28 天死亡率为 25%，1 年死亡率为 41%，两者均无随时间变化的趋势。
在全国性队列中，根据临床标准诊断的需要重症监护的脓毒症发病率在 11 年内没有变化。死亡率保持稳定，急诊科初步复苏仅观察到微小变化。
