Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier J C, Offenstadt G, Régnier B
Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France.
JAMA. 1995 Sep 27;274(12):968-74.
To examine the incidence, risk factors, and outcome of severe sepsis in intensive care unit (ICU) patients.
Inception cohort study from a 2-month prospective survey of 11,828 consecutive admissions to 170 adult ICUs of public hospitals in France.
Patients meeting clinical criteria for severe sepsis were included and classified as having documented infection (ie, documented severe sepsis, n = 742), or a clinical diagnosis of infection without microbiological documentation (ie, culture-negative severe sepsis, n = 310).
Hospital and 28-day mortality after severe sepsis.
Clinically suspected sepsis and confirmed severe sepsis occurred in 9.0 (95% confidence interval [CI], 8.5 to 9.5) and 6.3 (95% CI, 5.8 to 6.7) of 100 ICU admissions, respectively. The 28-day mortality was 56% (95% CI, 52% to 60%) in patients with severe sepsis, and 60% (95% CI, 55% to 66%) in those with culture-negative severe sepsis. Major determinants of both early (< 3 days) and secondary deaths in the whole cohort were the Simplified Acute Physiology Score (SAPS) II and the number of acute organ system failures. Other risk factors for early death included a low arterial blood pH (< 7.33) (P < .001) and shock (P = .03), whereas secondary deaths were associated with the admission category (P < .001), a rapidly or ultimately fatal underlying disease (P < .001), a preexisting liver (P = .01) or cardiovascular (P = .002) insufficiency, hypothermia (P = .02), thrombocytopenia (P = .01), and multiple sources of infection (P = .02). In patients with documented sepsis, bacteremia was associated with early mortality (P = .03).
Only three of four patients presenting with clinically suspected severe sepsis have documented infection. However, patients with clinically suspected sepsis but without microbiological documentation and patients with documented infection share common risk factors and are at similarly high risk of death. In addition to the severity of illness score, acute organ failures and the characteristics of underlying diseases should be accounted for in stratification of patients and outcome analyses.
研究重症监护病房（ICU）患者严重脓毒症的发病率、危险因素及预后。
一项前瞻性队列研究，对法国170家公立医院成人ICU连续收治的11828例患者进行了为期2个月的调查。
符合严重脓毒症临床标准的患者被纳入研究，并分为有感染记录者（即有记录的严重脓毒症，n = 742），或无微生物学记录的感染临床诊断患者（即血培养阴性的严重脓毒症，n = 310）。
严重脓毒症后的住院死亡率和28天死亡率。
临床上疑似脓毒症和确诊的严重脓毒症在每100例ICU入院患者中的发生率分别为9.0（95%置信区间[CI]，8.5至9.5）和6.3（95%CI，5.8至6.7）。严重脓毒症患者的28天死亡率为56%（95%CI，52%至60%），血培养阴性的严重脓毒症患者为60%（95%CI，55%至66%）。整个队列中早期（<3天）和继发性死亡的主要决定因素是简化急性生理学评分（SAPS）II和急性器官系统衰竭的数量。早期死亡的其他危险因素包括动脉血pH值低（<7.33）（P<.001）和休克（P =.03），而继发性死亡与入院类别（P<.001）、快速或最终致命的基础疾病（P<.001）、既往肝脏（P =.01）或心血管（P =.002）功能不全、体温过低（P =.02）、血小板减少（P =.01）以及多种感染源（P =.02）有关。在有感染记录的患者中，菌血症与早期死亡率相关（P =.03）。
临床上疑似严重脓毒症的患者中，只有四分之三有感染记录。然而，临床上疑似脓毒症但无微生物学记录的患者与有感染记录的患者具有共同的危险因素，且死亡风险同样高。除了疾病严重程度评分外，在对患者进行分层和预后分析时，还应考虑急性器官功能衰竭和基础疾病的特征。
