Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden.
Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
JAMA Netw Open. 2023 Aug 1;6(8):e2331168. doi: 10.1001/jamanetworkopen.2023.31168.
Despite the large health burden, reliable data on sepsis epidemiology are lacking; studies using International Statistical Classification of Diseases and Related Health Problems (ICD)-coded hospital discharge diagnosis for sepsis identification suffer from limited sensitivity. Also, ICD data do not allow investigation of underlying pathogens and antimicrobial resistance.
To generate reliable epidemiological estimates by linking data from a population-based database to a reference standard of clinical medical record review.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective, observational cohort study using a population-based administrative database including all acute care hospitals of the Scania region in Sweden in 2019 and 2020 to identify hospital-treated sepsis cases by ICD codes. From this database, clinical medical records were also selected for review within 6 strata defined by ICD discharge diagnosis (both with and without sepsis diagnosis). Data were analyzed from April to October 2022.
Hospital and population incidences of sepsis, case fatality, antimicrobial resistance, and temporal dynamics due to COVID-19 were assessed, as well as validity of ICD-10 case identification methods compared with the reference standard of clinical medical record review.
Out of 295 531 hospitalizations in 2019 in the Scania region of Sweden, 997 patient medical records were reviewed, among which 457 had sepsis according to clinical criteria. Of the patients with clinical sepsis, 232 (51%) were female, and 357 (78%) had at least 1 comorbidity. The median (IQR) age of the cohort was 76 (67-85) years. The incidence of sepsis in hospitalized patients according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in 2019 was 4.1% (95% CI, 3.6-4.5) by medical record review. This corresponds to an annual incidence rate of 747 (95% CI, 663-832) patients with sepsis per 100 000 population. No significant increase in sepsis during the COVID-19 pandemic nor a decrease in sepsis incidence when excluding COVID-19 sepsis was observed. Few sepsis cases caused by pathogens with antimicrobial resistance were found. The validity of ICD-10-based case identification in administrative data was low.
In this cohort study of sepsis epidemiology, sepsis was a considerable burden to public health in Sweden. Supplying administrative data with information from clinical medical records can help to generate reliable data on sepsis epidemiology.
尽管败血症带来了巨大的健康负担，但仍缺乏可靠的败血症流行病学数据；使用国际疾病分类（ICD）编码的医院出院诊断来识别败血症的研究，其敏感性有限。此外，ICD 数据无法调查潜在病原体和抗菌药物耐药性。
通过将基于人群的数据库中的数据与临床病历审查的参考标准相联系，生成可靠的流行病学估计值。
设计、设置和参与者：这是一项回顾性、观察性队列研究，使用基于人群的行政数据库，其中包括瑞典斯科讷地区 2019 年和 2020 年的所有急症护理医院，通过 ICD 编码识别医院治疗的败血症病例。从该数据库中，还根据 ICD 出院诊断（包括有和没有败血症诊断）将 6 个分层的临床病历进行选择，以进行审查。数据分析于 2022 年 4 月至 10 月进行。
评估了败血症的医院和人群发病率、病死率、抗菌药物耐药性以及由于 COVID-19 引起的时间动态变化，还评估了 ICD-10 病例识别方法与临床病历审查参考标准相比的有效性。
在瑞典斯科讷地区 2019 年的 295531 例住院治疗中，对 997 名患者的病历进行了审查，其中 457 例根据临床标准患有败血症。在患有临床败血症的患者中，有 232 名（51%）为女性，357 名（78%）至少患有 1 种合并症。队列的中位（IQR）年龄为 76（67-85）岁。根据 2019 年第三次国际败血症和脓毒症休克定义共识（Sepsis-3）标准，经病历审查，住院患者败血症的发病率为 4.1%（95%CI，3.6-4.5）。这相当于每 100000 人口中有 747 名（95%CI，663-832 名）败血症患者的年发病率。在 COVID-19 大流行期间，败血症的发病率没有明显增加，也没有观察到 COVID-19 败血症排除后败血症发病率的下降。发现很少有败血症病例是由具有抗菌药物耐药性的病原体引起的。基于 ICD-10 的病例识别在行政数据中的有效性较低。
在这项关于败血症流行病学的队列研究中，败血症给瑞典的公共卫生带来了相当大的负担。向行政数据提供临床病历信息有助于生成可靠的败血症流行病学数据。
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