Spoden Melissa, Hartog Christiane S, Schlattmann Peter, Freytag Antje, Ostermann Marlies, Wedekind Lisa, Storch Josephine, Reinhart Konrad, Günster Christian, Fleischmann-Struzek Carolin
Research Institute of the Local Health Care Funds (AOK), Berlin, Germany.
Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
Front Med (Lausanne). 2022 May 19;9:878337. doi: 10.3389/fmed.2022.878337. eCollection 2022.
Sepsis survival is associated with adverse outcomes. Knowledge about risk factors for adverse outcomes is lacking. We performed a population-based cohort study of 116,507 survivors of hospital-treated sepsis identified in health claims data of a German health insurance provider. We determined the development and risk factors for long-term adverse events: new dependency on chronic care, chronic dialysis, long-term respiratory support, and 12-month mortality. At-risk patients were defined by absence of these conditions prior to sepsis. Risk factors were identified using simple and multivariable logistic regression analyses. In the first year post-sepsis, 48.9% (56,957) of survivors had one or more adverse outcome, including new dependency on chronic care (31.9%), dialysis (2.8%) or respiratory support (1.6%), and death (30.7%). While pre-existing comorbidities adversely affected all studied outcomes (>4 comorbidities: OR 3.2 for chronic care, OR 4.9 for dialysis, OR 2.7 for respiratory support, OR 4.7 for 12-month mortality), increased age increased the odds for chronic care dependency and 12-month mortality, but not for dialysis or respiratory support. Hospital-acquired and multi-resistant infections were associated with increased risk of chronic care dependency, dialysis, and 12-month mortality. Multi-resistant infections also increased the odds of respiratory support. Urinary or respiratory infections or organ dysfunction increased the odds of new dialysis or respiratory support, respectively. Central nervous system infection and organ dysfunction had the highest OR for chronic care dependency among all infections and organ dysfunctions. Our results imply that patient- and infection-related factors have a differential impact on adverse life changing outcomes after sepsis. There is an urgent need for targeted interventions to reduce the risk.
脓毒症幸存者常伴有不良后果。目前尚缺乏关于不良后果风险因素的相关知识。我们基于德国一家健康保险公司的健康理赔数据，对116,507名接受过医院治疗的脓毒症幸存者进行了一项队列研究。我们确定了长期不良事件的发生情况及风险因素，包括对长期护理的新依赖、慢性透析、长期呼吸支持以及12个月死亡率。有风险的患者定义为在脓毒症发作前不存在这些情况。通过简单和多变量逻辑回归分析确定风险因素。在脓毒症后的第一年，48.9%（56,957名）幸存者出现了一种或多种不良后果，包括对长期护理的新依赖（31.9%）、透析（2.8%）或呼吸支持（1.6%）以及死亡（30.7%）。虽然既往合并症对所有研究结果均有不利影响（>4种合并症：长期护理的比值比为3.2，透析为4.9，呼吸支持为2.7，12个月死亡率为4.7），但年龄增加会增加长期护理依赖和12个月死亡率的几率，但对透析或呼吸支持无此影响。医院获得性感染和多重耐药感染与长期护理依赖、透析和12个月死亡率的风险增加相关。多重耐药感染也增加了呼吸支持的几率。泌尿系统或呼吸系统感染或器官功能障碍分别增加了新透析或呼吸支持的几率。在所有感染和器官功能障碍中，中枢神经系统感染和器官功能障碍导致长期护理依赖的比值比最高。我们的结果表明，患者相关因素和感染相关因素对脓毒症后改变生活的不良后果有不同影响。迫切需要采取针对性干预措施以降低风险。
