Imaeda Taro, Oami Takehiko, Takahashi Nozomi, Saito Daiki, Higashi Akiko, Nakada Taka-Aki
Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan.
Acute Med Surg. 2023 Oct 12;10(1):e890. doi: 10.1002/ams2.890. eCollection 2023 Jan-Dec.
Sepsis is the leading cause of death worldwide. Considering regional variations in the characteristics of patients with sepsis, a better understanding of the epidemiology in Japan will lead to further development of strategies for the prevention and treatment of sepsis. To investigate the epidemiology of sepsis, we conducted a systematic literature review of PubMed between 2003 and January 2023. Among the 78 studies using a Japanese administrative database, we included 20 that defined patients with sepsis as those with an infection and organ dysfunction. The mortality rate in patients with sepsis has decreased since 2010, reaching 18% in 2017. However, the proportion of inpatients with sepsis is increasing. A study comparing short-course (≤7 days) and long-course (≥8 days) antibiotic administration showed lower 28-day mortality in the short-course group. Six studies on the treatment of patients with septic shock reported that low-dose corticosteroids or polymyxin B hemoperfusion reduced mortality, whereas intravenous immunoglobulins had no such effect. Four studies investigating the effects of treatment in patients with sepsis-associated disseminated intravascular coagulation demonstrated that antithrombin may reduce mortality, whereas recombinant human soluble thrombomodulin does not. A descriptive study of medical costs for patients with sepsis showed that the effective cost per survivor decreased over an 8-year period from 2010 to 2017. Sepsis has a significant impact on public health, and is attracting attention as an ongoing issue. Further research to determine more appropriate prevention methods and treatment for sepsis should be a matter of priority.
脓毒症是全球主要的死亡原因。考虑到脓毒症患者特征的地区差异，更好地了解日本的流行病学情况将有助于脓毒症预防和治疗策略的进一步发展。为了调查脓毒症的流行病学情况，我们对2003年至2023年1月期间的PubMed进行了系统的文献综述。在78项使用日本行政数据库的研究中，我们纳入了20项将脓毒症患者定义为有感染和器官功能障碍的研究。自2010年以来，脓毒症患者的死亡率有所下降，2017年达到18%。然而，脓毒症住院患者的比例正在上升。一项比较短期（≤7天）和长期（≥8天）抗生素给药的研究表明，短期给药组的28天死亡率较低。六项关于感染性休克患者治疗的研究报告称，低剂量皮质类固醇或多粘菌素B血液灌流可降低死亡率，而静脉注射免疫球蛋白则无此效果。四项调查脓毒症相关弥散性血管内凝血患者治疗效果的研究表明，抗凝血酶可能降低死亡率，而重组人可溶性血栓调节蛋白则不然。一项关于脓毒症患者医疗费用的描述性研究表明，从2010年到2017年的8年期间，每位幸存者的有效成本有所下降。脓毒症对公众健康有重大影响，作为一个持续存在的问题正受到关注。确定更合适的脓毒症预防方法和治疗方法的进一步研究应成为优先事项。
