The epidemiology of sepsis in the United States from 1979 through 2000
The epidemiology of sepsis in the United States from 1979 through 2000
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DOI：
10.1056/nejmoa022139
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发表时间：
2003-04-17
影响因子：
158.5
通讯作者：
Moss, M
中科院分区：
文献类型：
--
作者：
Martin, GS;Mannino, DM;Moss, M
背景：败血症代表着重大的医疗保健负担，关于败血症人口统计学或其发病率和结果的时间变化的流行病学信息有限。我们调查了美国败血症的流行病学，对种族和性别，因果生物，患者的处置以及发病率和结局进行了特定的检查。在美国的所有非联邦急诊医院中。有关新病例的数据是从根据疾病的国际分类，第九修订，临床修改编码的医院出院记录获得的。分析：在美国22年中大约7.5亿住院的出院数据审查，确定了10,319,418例败血症。败血症比男性在男性中比女性更普遍（平均年相对风险，1.28 [95％的置信区间，1.24至1.32]）和非白人人群中的败血症比白人（平均年相对风险，1.90 [95％的置信区间，1.81 to 1.81） 2.00]）。在1979年至2000年之间，败血症的发生率每年增加8.7％，从约164,000例（每100,000人口82.7例）增加到近660,000例（每100,000人240.4例）。由于真菌生物引起的败血症的发生率增加了207％，革兰氏阳性细菌成为1987年以后的主要病原体。总院内死亡率从1979年的27.8％下降到从1984年到1984年的17.9％。 1995年至2000年，死亡总数继续增加。在黑人中，死亡率最高。器官衰竭累计导致死亡率，并且器官少于三个失败的患者的生存时间有所改善。住院的平均长度减少，非急性护理医疗设施的排放率增加了：缔结：败血症的发病率和败血症相关的死亡人数正在增加，尽管败血症患者的总体死亡率正在下降。种族之间以及败血症发生的男女之间也存在差异。革兰氏阳性细菌和真菌生物越来越常见败血症。
BACKGROUND:Sepsis represents a substantial health care burden, and there is limited epidemiologic information about the demography of sepsis or about the temporal changes in its incidence and outcome. We investigated the epidemiology of sepsis in the United States, with specific examination of race and sex, causative organisms, the disposition of patients, and the incidence and outcome.METHODS:We analyzed the occurrence of sepsis from 1979 through 2000 using a nationally representative sample of all nonfederal acute care hospitals in the United States. Data on new cases were obtained from hospital discharge records coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification.RESULTS:Review of discharge data on approximately 750 million hospitalizations in the United States over the 22-year period identified 10,319,418 cases of sepsis. Sepsis was more common among men than among women (mean annual relative risk, 1.28 [95 percent confidence interval, 1.24 to 1.32]) and among nonwhite persons than among white persons (mean annual relative risk, 1.90 [95 percent confidence interval, 1.81 to 2.00]). Between 1979 and 2000, there was an annualized increase in the incidence of sepsis of 8.7 percent, from about 164,000 cases (82.7 per 100,000 population) to nearly 660,000 cases (240.4 per 100,000 population). The rate of sepsis due to fungal organisms increased by 207 percent, with gram-positive bacteria becoming the predominant pathogens after 1987. The total in-hospital mortality rate fell from 27.8 percent during the period from 1979 through 1984 to 17.9 percent during the period from 1995 through 2000, yet the total number of deaths continued to increase. Mortality was highest among black men. Organ failure contributed cumulatively to mortality, with temporal improvements in survival among patients with fewer than three failing organs. The average length of the hospital stay decreased, and the rate of discharge to nonacute care medical facilities increased.CONCLUSIONS:The incidence of sepsis and the number of sepsis-related deaths are increasing, although the overall mortality rate among patients with sepsis is declining. There are also disparities among races and between men and women in the incidence of sepsis. Gram-positive bacteria and fungal organisms are increasingly common causes of sepsis.