儿童脓毒症患者的住院病例数量与死亡率之间的关联：一项使用日本全国住院患者数据库的回顾性观察研究。
Association between hospital case volume and mortality in pediatric sepsis: A retrospective observational study using a Japanese nationwide inpatient database.
作者信息
Ohki Shingo, Otani Makoto, Tomioka Shinichi, Komiya Kosaku, Kawamura Hideki, Nakada Taka-Aki, Nakagawa Satoshi, Matsuda Shinya, Shime Nobuaki
机构信息
Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Shonan Kamakura General Hospital, Kamakura, Japan.
出版信息
J Crit Care Med (Targu Mures). 2025 Jan 31;11(1):87-94. doi: 10.2478/jccm-2025-0006. eCollection 2025 Jan.
INTRODUCTION
The survival benefits of treatment at high-volume hospitals (HVHs) are well-documented for several critical pediatric conditions. However, their impact on pediatric sepsis, a leading cause of mortality among children, remains understudied.
AIM OF THE STUDY
To investigate the association between hospital case volume and mortality rates in pediatric sepsis.
MATERIAL AND METHODS
We conducted a retrospective cohort study using data from the Diagnosis Procedure Combination database. The study included patients who met the following criteria: 1) aged 28 days to 17 years; 2) discharged from the hospital between April 2014 and March 2018; 3) had a sepsis diagnosis coded under the International Classification of Diseases, 10th revision; 4) underwent blood cultures on hospital admission day (day 0) or day 1; 5) received antimicrobial agents on day 0 or 1; and 6) required at least one organ support measure (e.g., mechanical ventilation or vasopressors) on day 0 or 1. Hospitals were categorized by case volume during the study period, with HVHs defined as those in the highest quartile and low-volume hospitals (LVHs) as those in the remaining quartiles. In-hospital mortality rates between HVH and LVH groups were compared using mixed-effects logistic regression analysis with propensity score (PS) matching.
RESULTS
A total of 934 pediatric patients were included in the study, with an overall in-hospital mortality rate of 16.1%. Of them, 234 were treated at 5 HVHs (≥26 patients in 4 years), and 700 at 234 LVHs (<26 patients in 4 years). Upon PS matching, patients treated at HVHs demonstrated significantly lower odds of in-hospital mortality compared with those treated at LVHs (odds ratio, 0.42; 95% confidence interval, 0.22-0.80; P = 0.008).
CONCLUSIONS
In pediatric patients with sepsis, treatment at HVHs was associated with lower odds of in-hospital mortality.
引言
高容量医院（HVHs）对几种关键儿科疾病的治疗具有生存益处，这已得到充分证明。然而，它们对儿童败血症（儿童死亡的主要原因之一）的影响仍未得到充分研究。
研究目的
调查儿科败血症患者的医院病例数量与死亡率之间的关联。
材料与方法
我们使用诊断程序组合数据库的数据进行了一项回顾性队列研究。该研究纳入了符合以下标准的患者：1）年龄在28天至17岁之间；2）2014年4月至2018年3月期间出院；3）败血症诊断按照《国际疾病分类》第10版进行编码；4）入院当天（第0天）或第1天进行了血培养；5）在第0天或第1天接受了抗菌药物治疗；6）在第0天或第1天需要至少一种器官支持措施（例如机械通气或血管升压药）。根据研究期间的病例数量对医院进行分类，高容量医院定义为处于最高四分位数的医院，低容量医院（LVHs）定义为处于其余四分位数的医院。使用倾向评分（PS）匹配的混合效应逻辑回归分析比较高容量医院和低容量医院组之间的院内死亡率。
结果
该研究共纳入934例儿科患者，总体院内死亡率为16.1%。其中，234例在5家高容量医院接受治疗（4年内≥26例患者），700例在234家低容量医院接受治疗（4年内<26例患者）。倾向评分匹配后，与在低容量医院接受治疗的患者相比，在高容量医院接受治疗的患者院内死亡几率显著降低（优势比，0.42；95%置信区间，0.22 - 0.80；P = 0.008）。
结论
在患有败血症的儿科患者中，在高容量医院接受治疗与较低的院内死亡几率相关。
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