Aix-Marseille University, AP-HM, North Hospital, Department of Anaesthesia and Intensive Care Medicine, France.
Aix-Marseille University, AP-HM, North Hospital, Department of Anaesthesia and Intensive Care Medicine, France.
Anaesth Crit Care Pain Med. 2022 Jun;41(3):101082. doi: 10.1016/j.accpm.2022.101082. Epub 2022 Apr 25.
Septic shock is responsible for high morbidity and mortality rates and its incidence is increasing worldwide. Its evolution over the last few years and the leverage points for action to improve associated outcomes remain unclear. Our aim was to determine trends in the incidence and mortality of septic shock and associated risk factors in intensive care unit (ICU) patients and readmission rates after hospital discharge.
We performed a retrospective cohort study using data from the French national hospitalisation database, including adult patients with septic shock from 2014 to 2018. Primary outcomes were the incidence of septic shock and the hospital mortality rate at 30, 90 and 365 days. Secondary outcomes were all-cause hospital readmission.
Septic shock was identified in 187,587 ICU stays. The age- and sex-adjusted incidence rate of septic shock per 100 ICU admissions increased from 6.5% to 6.8% (P < .001); age- and sex-adjusted hospital mortality rates decreased from 47.3% to 44.5% (P < .001). The hospital readmission rate at 365 days was 65.0%. Older age, higher Charlson score, occurrence of organ failure and previous hospitalisation were associated with increased risk of mortality. Identification of a specific microorganism and a time between hospitalisation and ICU admission of less than one day were associated with a decreased risk of death.
Our study revealed an increase in the incidence of septic shock and a decrease in mortality rates. Pathogen identification and rapid admission to the ICU were associated with better outcomes. The rate of hospital readmission increased, raising questions about the discharge criteria for these patients.
感染性休克导致高发病率和高死亡率，其发病率在全球范围内呈上升趋势。其在过去几年中的演变以及改善相关结局的行动重点尚不清楚。我们的目的是确定重症监护病房（ICU）患者感染性休克的发病率和死亡率趋势以及相关风险因素，并确定出院后再入院率。
我们使用法国国家住院数据库中的数据进行了回顾性队列研究，其中包括 2014 年至 2018 年患有感染性休克的成年患者。主要结局是感染性休克的发病率和 30、90 和 365 天的医院死亡率。次要结局是全因医院再入院。
在 187587 例 ICU 入住中确定了感染性休克。每 100 例 ICU 入院的年龄和性别调整后的感染性休克发病率从 6.5%增加到 6.8%（P<.001）；年龄和性别调整后的医院死亡率从 47.3%下降到 44.5%（P<.001）。365 天的医院再入院率为 65.0%。年龄较大、Charlson 评分较高、发生器官衰竭和以前住院与死亡率增加相关。鉴定特定的微生物和住院与 ICU 入院之间的时间少于一天与死亡风险降低相关。
我们的研究表明感染性休克的发病率增加，死亡率下降。病原体鉴定和快速入住 ICU 与更好的结局相关。医院再入院率增加，这引发了对这些患者出院标准的质疑。
