成年人输尿管镜检查术后脓毒症的患病率及其相关的住院和死亡率。

Sepsis prevalence and associated hospital admission and mortality after ureteroscopy in employed adults.

机构信息

Division of Urology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.

Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.

出版信息

BJU Int. 2023 Aug;132(2):210-216. doi: 10.1111/bju.16029. Epub 2023 Apr 25.

DOI:10.1111/bju.16029

PMID:37057736

Abstract

OBJECTIVE

To determine 30-day inpatient mortality, intensive care unit (ICU) admissions, inpatient admissions/readmissions, and yearly trends in sepsis prevalence and inpatient mortality after ureteroscopy (URS) in employed adults.

MATERIALS AND METHODS

We performed a retrospective analysis of the IBM MarketScan Commercial Database to identify employed adults aged 18-64 years who underwent URS between 2015 and 2019. Patients were categorized as having no sepsis (controls), non-severe sepsis, or severe sepsis within 30 days of URS. The main outcomes included inpatient mortality, ICU admissions, inpatient admissions, readmissions, and annual rates of sepsis and associated inpatient mortality.

RESULTS

Among 109 496 patients undergoing URS, 5.6% developed sepsis (4.1% non-severe, 1.5% severe). The 30-day inpatient mortality rates were 0.03%, 0.3% and 2.5% for controls, non-severe sepsis and severe sepsis, respectively (P < 0.001). In a multivariable analysis, diagnosis of sepsis regardless of severity (hazard ratio [HR] 17.2, 95% confidence interval [CI] 10.5-28.1; P < 0.001) or severe sepsis (HR 49.5, 95% CI 28.9-84.7; P < 0.001) increased the risk of 30-day inpatient mortality compared to no sepsis (controls). ICU admissions on the day of procedure (1.5%, 19.8% and 52.4%), inpatient admission rates (18.3%, 74.9% and 76.9%) and readmission rates (7.1%, 12.0% and 15.9%) were higher with severe sepsis and non-severe sepsis vs controls (all P < 0.001). During the study period, the prevalence of sepsis after URS increased from 4.7% to 6.6% (P < 0.001), while the associated mortality rate decreased from 0.7% to 0.2% (P < 0.001).

CONCLUSION

Among working adults aged 18-64 years, sepsis after URS increases the risk of 30-day inpatient mortality, ICU and hospital admission, and hospital readmission. Although the prevalence of sepsis after URS is increasing over time, associated mortality rates are declining. Urologists should be aware of the potentially deadly consequences of sepsis after URS in younger patients.

摘要

目的

确定在接受输尿管镜检查（URS）后的 30 天内住院死亡率、重症监护病房（ICU）入院率、住院入院/再入院率，以及脓毒症的年流行率和住院死亡率。

材料和方法

我们对 IBM MarketScan 商业数据库进行了回顾性分析，以确定在 2015 年至 2019 年期间接受 URS 的 18-64 岁的在职成年人。患者在 URS 后 30 天内被分为无脓毒症（对照组）、非严重脓毒症或严重脓毒症。主要结果包括住院死亡率、ICU 入院率、住院入院率、再入院率以及脓毒症和相关住院死亡率的年发生率。

结果

在 109496 例接受 URS 的患者中，5.6%发生了脓毒症（4.1%为非严重脓毒症，1.5%为严重脓毒症）。对照组、非严重脓毒症组和严重脓毒症组的 30 天住院死亡率分别为 0.03%、0.3%和 2.5%（P<0.001）。在多变量分析中，无论严重程度如何，脓毒症的诊断（风险比[HR]17.2，95%置信区间[CI]10.5-28.1；P<0.001）或严重脓毒症（HR 49.5，95%CI 28.9-84.7；P<0.001）均增加了与无脓毒症（对照组）相比，30 天住院死亡率的风险。在手术当天，ICU 入院率（1.5%、19.8%和 52.4%）、住院入院率（18.3%、74.9%和 76.9%）和再入院率（7.1%、12.0%和 15.9%）在严重脓毒症和非严重脓毒症患者中均高于对照组（均 P<0.001）。在研究期间，URS 后脓毒症的流行率从 4.7%增加到 6.6%（P<0.001），而相关死亡率从 0.7%下降到 0.2%（P<0.001）。