Ling Lowell, Zhang Jack Zhenhe, Chang Lok Ching, Chiu Lok Ching Sandra, Ho Samantha, Ng Pauline Yeung, Dharmangadan Manimala, Lau Chi Ho, Ling Steven, Man Man Yee, Fong Ka Man, Liong Ting, Yeung Alwin Wai Tak, Au Gary Ka Fai, Chan Jacky Ka Hing, Tang Michele, Liu Ying Zhi, Wu William Ka Kei, Wong Wai Tat, Wu Peng, Cowling Benjamin J, Lee Anna, Rhee Chanu
Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
Critical Care Medicine Unit, The University of Hong Kong, Hong Kong SAR, China.
Clin Infect Dis. 2025 Feb 5;80(1):91-100. doi: 10.1093/cid/ciad491.
Sepsis surveillance using electronic health record (EHR)-based data may provide more accurate epidemiologic estimates than administrative data, but experience with this approach to estimate population-level sepsis burden is lacking.
This was a retrospective cohort study including all adults admitted to publicly funded hospitals in Hong Kong between 2009 and 2018. Sepsis was defined as clinical evidence of presumed infection (clinical cultures and treatment with antibiotics) and concurrent acute organ dysfunction (≥2-point increase in baseline Sequential Organ Failure Assessment [SOFA] score). Trends in incidence, mortality, and case fatality risk (CFR) were modeled by exponential regression. Performance of the EHR-based definition was compared with 4 administrative definitions using 500 medical record reviews.
Among 13 540 945 hospital episodes during the study period, 484 541 (3.6%) had sepsis by EHR-based criteria with 22.4% CFR. In 2018, age- and sex-adjusted standardized sepsis incidence was 756 per 100 000 (relative change: +2.8%/y [95% CI: 2.0%-3.7%] between 2009 and 2018) and standardized sepsis mortality was 156 per 100 000 (relative change: +1.9%/y; 95% CI: .9%-2.8%). Despite decreasing CFR (relative change: -0.5%/y; 95% CI: -1.0%, -.1%), sepsis accounted for an increasing proportion of all deaths (relative change: +3.9%/y; 95% CI: 2.9%-4.8%). Medical record reviews demonstrated that the EHR-based definition more accurately identified sepsis than administrative definitions (area under the curve [AUC]: .91 vs .52-.55; P < .001).
An objective EHR-based surveillance definition demonstrated an increase in population-level standardized sepsis incidence and mortality in Hong Kong between 2009 and 2018 and was much more accurate than administrative definitions. These findings demonstrate the feasibility and advantages of an EHR-based approach for widescale sepsis surveillance.
与行政数据相比，使用基于电子健康记录（EHR）的数据进行脓毒症监测可能能提供更准确的流行病学估计，但缺乏用这种方法来估计人群水平脓毒症负担的经验。
这是一项回顾性队列研究，纳入了2009年至2018年间在香港公立医院住院的所有成年人。脓毒症定义为存在疑似感染的临床证据（临床培养及抗生素治疗）以及并发急性器官功能障碍（基线序贯器官衰竭评估[SOFA]评分增加≥2分）。通过指数回归对发病率、死亡率和病死率风险（CFR）的趋势进行建模。使用500份病历回顾，将基于EHR的定义的性能与4种行政定义进行比较。
在研究期间的13540945次住院病例中，根据基于EHR的标准，有484541例（3.6%）发生脓毒症，病死率为22.4%。2018年，年龄和性别调整后的标准化脓毒症发病率为每10万人756例（相对变化：2009年至2018年间为+2.8%/年[95%CI：2.0%-3.7%]），标准化脓毒症死亡率为每10万人156例（相对变化：+1.9%/年；95%CI：0.9%-2.8%）。尽管CFR下降（相对变化：-0.5%/年；95%CI：-1.0%，-0.1%），但脓毒症在所有死亡中所占比例却在增加（相对变化：+3.9%/年；95%CI：2.9%-4.8%）。病历回顾表明，基于EHR的定义比行政定义能更准确地识别脓毒症（曲线下面积[AUC]：0.91对0.52-0.55；P<0.001）。
一个客观的基于EHR的监测定义显示，2009年至2018年间香港人群水平的标准化脓毒症发病率和死亡率有所上升，且比行政定义准确得多。这些发现证明了基于EHR的方法用于大规模脓毒症监测的可行性和优势。
