Liddy Emer M, Amin Doaa K, McKeown Declan J, O'Dwyer Michael J, Vellinga Akke
Department of Public Health, Health Service Executive Dublin & South East and School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
CARA Network, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
Crit Care Explor. 2025 Jul 15;7(7):e1289. doi: 10.1097/CCE.0000000000001289. eCollection 2025 Jul 1.
Sepsis is a leading cause of morbidity and mortality. Understanding sepsis epidemiology is crucial to enable clinicians to identify patients at highest risk of developing and dying from sepsis.
While community-acquired (CA) sepsis has been identified as more common than hospital-acquired (HA) sepsis, HA sepsis has led to increased morbidity and mortality. Few studies, however, have analyzed CA and HA sepsis by site of infection or by patient comorbidities. The aim of this analysis was to describe the epidemiology of patients with CA and HA sepsis diagnosed in Ireland.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study. The setting was all Irish acute public hospitals from 2016 to 2022. Data were extracted from the Hospital In-Patient Enquiry (HIPE) system recording all discharges from acute public hospitals, if a sepsis-related diagnostic code was included.
Univariate and multivariate analysis was conducted to compare CA and HA sepsis events and their association with sepsis-associated mortality.
The number of CA vs. HA sepsis events in the database was 86,011 (85.2%) vs. 14,930 (14.8%). HA sepsis patients were 1.5 times more likely to die in hospital compared with CA. Of diagnoses analyzed, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the strongest risk factor predictive of mortality (odds ratio [OR] = 2.4) followed by cardiac disease (OR, 1.9) and influenza or pneumonia (OR, 1.9). Sepsis patients with a lower socioeconomic status had a 20% higher likelihood of death.
This analysis highlighted a significant increased risk of sepsis-associated mortality for patients diagnosed with sepsis as a result of a HA infection and key infection types and comorbidities including SARS-CoV-2, influenza or pneumonia, cancer, and cardiac disease.
脓毒症是发病和死亡的主要原因。了解脓毒症流行病学对于临床医生识别发生脓毒症及因脓毒症死亡风险最高的患者至关重要。
虽然社区获得性（CA）脓毒症已被确定比医院获得性（HA）脓毒症更常见，但HA脓毒症导致发病率和死亡率增加。然而，很少有研究按感染部位或患者合并症分析CA和HA脓毒症。本分析的目的是描述在爱尔兰诊断出的CA和HA脓毒症患者的流行病学情况。
设计、背景和参与者：这是一项回顾性队列研究。研究背景为2016年至2022年爱尔兰所有急性公立医院。若包含与脓毒症相关的诊断代码，则从医院住院患者查询（HIPE）系统中提取记录所有急性公立医院出院情况的数据。
进行单因素和多因素分析以比较CA和HA脓毒症事件及其与脓毒症相关死亡率的关联。
数据库中CA与HA脓毒症事件的数量分别为86,011例（85.2%）和14,930例（14.8%）。与CA脓毒症患者相比，HA脓毒症患者在医院死亡的可能性高1.5倍。在分析的诊断中，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）被确定为预测死亡率的最强风险因素（优势比[OR]=2.4），其次是心脏病（OR，1.9）和流感或肺炎（OR，1.9）。社会经济地位较低的脓毒症患者死亡可能性高20%。
本分析强调，因HA感染导致脓毒症的患者以及包括SARS-CoV-2、流感或肺炎、癌症和心脏病在内的关键感染类型和合并症患者，其脓毒症相关死亡率显著增加。
