Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*.
Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*.
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DOI：
10.1097/ccm.0000000000000026
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发表时间：
2014-03
影响因子：
8.8
通讯作者：
Walkey AJ
中科院分区：
文献类型：
--
作者：
Stevenson EK;Rubenstein AR;Radin GT;Wiener RS;Walkey AJ
根据管理数据得出的严重脓毒症死亡率趋势可能因ICD-9-CM编码实践的改变而产生偏倚。我们试图使用不依赖ICD-9-CM编码的临床试验数据确定严重脓毒症死亡率的时间趋势，并将试验数据中的死亡率趋势与管理数据中观察到的死亡率趋势进行比较。我们在MEDLINE中检索了1991 - 2009年招募严重脓毒症患者的多中心随机试验。我们根据观察到的常规护理参与者的28天死亡率计算每个试验的标准化死亡率（SMR），并根据疾病严重程度评分预测死亡率。为了比较临床试验和管理数据的死亡率趋势，我们使用两种先前验证的算法确定了1993 - 2009年全国住院患者样本中的成人严重脓毒症住院。严重脓毒症或脓毒性休克住院患者。在3244篇可能符合条件的文章中，我们纳入了36项多中心严重脓毒症试验，常规治疗组共有14,418例受试者，接受常规治疗的严重脓毒症受试者28天死亡率为33.2%。观察到的死亡率每年下降3.0%（95% CI 0.8%，5.0%，p = 0.009），从46.9%下降[SMR 0.94，95% CI（0.86，1.03）]至2006 - 2009年期间的29%[SMR 0.53，（95% CI（0.50，0.57）]（每年变化3.0%）。从管理数据中确定的严重脓毒症患者的住院死亡率趋势["安格斯定义"：4.7%年变化，（95% CI 4.1%，5.3%），p = 0.69），"马丁定义"：3.5%年变化，（95% CI 3.0%，4.1%，p = 0.97）]与从临床试验中确定的趋势相似。自1991年以来，在多中心随机试验的常规治疗组中登记的严重脓毒症患者的死亡率下降。在临床试验参与者中确定的死亡率趋势似乎与使用管理数据确定的死亡率趋势相似，并支持使用管理数据监测重度脓毒症患者的死亡率趋势。
Trends in severe sepsis mortality derived from administrative data may be biased by changing ICD-9-CM coding practices. We sought to determine temporal trends in severe sepsis mortality using clinical trial data that does not rely on ICD-9-CM coding and compare mortality trends in trial data to those observed from administrative data. We searched MEDLINE for multicenter, randomized trials that enrolled patients with severe sepsis from 1991-2009. We calculated standardized mortality ratios (SMR) for each trial from observed 28-day mortality of usual care participants and predicted mortality from severity of illness scores. To compare mortality trends from clinical trials to administrative data, we identified adult severe sepsis hospitalizations in the Nationwide Inpatient Sample, 1993-2009, using two previously validated algorithms. Hospitalized patients with severe sepsis or septic shock. Of 3244 potentially eligible articles, we included 36 multicenter severe sepsis trials, with a total of 14,418 participants in a usual care arm. Participants with severe sepsis receiving usual care had a 28-day mortality of 33.2%. Observed mortality decreased 3.0% annually (95% CI 0.8%, 5.0%, p=0.009), decreasing from 46.9% [SMR 0.94, 95% CI (0.86, 1.03)] during years 1991-1995 to 29% [SMR 0.53, (95% CI (0.50, 0.57)] during years 2006-2009 (3.0% annual change). Trends in hospital mortality among patients with severe sepsis identified from administrative data [“Angus definition”: 4.7% annual change, (95% CI 4.1%, 5.3%), p=0.69), “Martin definition”: 3.5% annual change, (95% CI 3.0%, 4.1%, p=0.97)] were similar to trends identified from clinical trials. Since 1991, patients with severe sepsis enrolled in usual care arms of multicenter randomized trials have experienced decreasing mortality. The mortality trends identified in clinical trial participants appear similar to those identified using administrative data and support the use of administrative data to monitor mortality trends in patients with severe sepsis.