Department of Infectious Disease, Nordland Hospital Trust, Parkveien 95, 8005, Bodø, Norway.
UiT the Arctic University of Norway, Faculty of Health Sciences, Hansine Hanses vei 14, 9037, Tromsø, Norway.
Infection. 2023 Aug;51(4):1103-1115. doi: 10.1007/s15010-023-02013-y. Epub 2023 Mar 9.
To examine the prevalence of advanced frailty, comorbidity, and age among sepsis-related deaths in an adult hospital population.
Retrospective chart reviews of deceased adults within a Norwegian hospital trust, with a diagnosis of infection, over 2 years (2018-2019). The likelihood of sepsis-related death was evaluated by clinicians as sepsis-related, possibly sepsis-related, or not sepsis-related.
Of 633 hospital deaths, 179 (28%) were sepsis-related, and 136 (21%) were possibly sepsis-related. Among these 315 patients whose deaths were sepsis-related or possibly sepsis-related, close to three in four patients (73%) were either 85 years or older, living with severe frailty (Clinical Frailty Scale, CFS, score of 7 or more), or an end-stage condition prior to the admission. Among the remaining 27%, 15% were either 80-84 years old, living with frailty corresponding to a CFS score of 6, or severe comorbidity, defined as 5 points or more on the Charlson Comorbidity Index (CCI). The last 12% constituted the presumably healthiest cluster, but in this group as well, the majority died with limitations of care due to their premorbid functional status and/ or comorbidity. Findings remained stable if the population was limited to sepsis-related deaths on clinicians' reviews or those fulfilling the Sepsis-3 criteria.
Advanced frailty, comorbidity, and age were predominant in hospital fatalities where infection contributed to death, with or without sepsis. This is of importance when considering sepsis-related mortality in similar populations, the applicability of study results to everyday clinical work, and future study designs.
在一家成人医院人群中，调查与脓毒症相关的死亡病例中，严重衰弱、合并症和年龄的流行情况。
对挪威一家医院信托中，2 年内（2018-2019 年）患有感染的已故成年人进行回顾性病历审查。临床医生评估脓毒症相关死亡的可能性为与脓毒症相关、可能与脓毒症相关或与脓毒症不相关。
在 633 例医院死亡中，179 例（28%）与脓毒症相关，136 例（21%）可能与脓毒症相关。在这些与脓毒症相关或可能与脓毒症相关的 315 名患者中，近四分之三的患者（73%）为 85 岁或以上，患有严重衰弱（临床虚弱量表，CFS，评分为 7 或更高）或在入院前处于终末期状态。在其余的 27%中，15%为 80-84 岁，患有衰弱，相当于 CFS 评分为 6，或严重合并症，定义为 Charlson 合并症指数（CCI）得分为 5 分或以上。最后 12%构成了推测最健康的群体，但在这个群体中，大多数人由于其发病前的功能状态和/或合并症而死于护理受限。如果将人群限制为临床医生评估的与脓毒症相关的死亡或符合 Sepsis-3 标准的死亡，研究结果仍然稳定。
在感染导致死亡的情况下，无论是否存在脓毒症，严重衰弱、合并症和年龄在医院死亡中占主导地位。在考虑类似人群中的脓毒症相关死亡率、研究结果对日常临床工作的适用性和未来研究设计时，这一点很重要。
