Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China.
Crit Care. 2022 Jun 4;26(1):161. doi: 10.1186/s13054-022-04035-8.
The burden of sepsis remains high in China. The relationship between case volume and hospital mortality among patients with septic shock, the most severe complication of sepsis, is unknown in China.
In this retrospective cohort study, we analyzed surveillance data from a national quality improvement program in intensive care units (ICUs) in China in 2020. Association between septic shock case volume and hospital mortality was analyzed using multivariate linear regression and restricted cubic splines.
We enrolled a total of 134,046 septic shock cases in ICUs from 1902 hospitals in China during 2020. In this septic shock cohort, the median septic shock volume per hospital was 33 cases (interquartile range 14-76 cases), 41.4% were female, and more than half of the patients were over 61 years old, with average hospital mortality of 21.2%. An increase in case volume was associated with improved survival among septic shock cases. In the linear regression model, the highest quartile of septic shock volume was associated with lower hospital mortality compared with the lowest quartile (β - 0.86; 95% CI - 0.98, - 0.74; p < 0.001). Similar differences were found in hospitals of respective geographic locations and hospital levels. With case volume modeled as a continuous variable in a restricted cubic spline, a lower volume threshold of 40 cases before which a substantial reduction of the hospital mortality rate was observed.
The findings suggest that hospitals with higher septic shock case volume have lower hospital mortality in China. Further research is needed to explain the mechanism of this volume-outcome relationship.
脓毒症的负担在中国仍然很高。脓毒症最严重的并发症——感染性休克患者的病例数量与医院死亡率之间的关系在中国尚不清楚。
在这项回顾性队列研究中，我们分析了 2020 年中国重症监护病房（ICU）国家质量改进计划的监测数据。使用多元线性回归和限制立方样条分析感染性休克病例数量与医院死亡率之间的关系。
我们共纳入了 2020 年来自中国 1902 家医院的 ICU 中总计 134046 例感染性休克病例。在这个感染性休克队列中，医院的感染性休克中位数为 33 例（四分位距为 14-76 例），41.4%为女性，超过一半的患者年龄超过 61 岁，平均医院死亡率为 21.2%。病例数量的增加与感染性休克患者生存率的提高相关。在线性回归模型中，与最低四分位数相比，第四四分位数的感染性休克数量与较低的医院死亡率相关（β=-0.86；95%置信区间-0.98，-0.74；p<0.001）。在各自地理位置和医院级别的医院中也发现了类似的差异。在限制立方样条中，将病例数量建模为连续变量时，观察到医院死亡率显著降低的病例数量阈值较低，为 40 例。
这些发现表明，中国感染性休克病例数量较高的医院的医院死亡率较低。需要进一步研究来解释这种数量-结果关系的机制。
