Long-term mortality and medical care charges in patients with severe sepsis
Long-term mortality and medical care charges in patients with severe sepsis
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DOI：
10.1097/01.ccm.0000085178.80226.0b
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发表时间：
2003-09-01
影响因子：
8.8
通讯作者：
Oster, G
中科院分区：
文献类型：
--
作者：
Weycker, D;Akhras, KS;Oster, G
目的：估计严重败血症患者的长期死亡率和医疗费用。设计：回顾性队列研究。背景：大型、综合、地域多样的美国健康保险索赔数据库，每年覆盖 300 万人。患者：1991 年 1 月 1 日至 2000 年 8 月 31 日期间住院的所有患有细菌或真菌感染和急性器官功能障碍（严重败血症）的人。干预措施：无。测量和主要结果：对所有患者进行随访，从因严重脓毒症住院（指数入院）之日起至 2000 年 8 月 31 日、退出健康计划或死亡（以先发生者为准）。感兴趣的指标包括死亡率和医疗费用，并使用生存分析技术对指数入院、指数入院后 90 天和 180 天以及此后每年（最多 5 年）进行估计。总共确定了 16,019 名符合研究进入标准的患者。大多数患者（81.2%）年龄大于或等于65岁； 53.4%为男性。指数入院时的死亡率为 21.2%，1 年死亡率为 51.4%，5 年死亡率为 74.2%。指数入院的平均累计总医疗费用为 44,600 美元，一年为 78,500 美元，五年为 118,800 美元。住院费用占医疗费用总额的最大部分。结论：严重脓毒症患者在急性病期及病后的死亡率和经济成本较高。
Objective: To estimate long-term mortality and medical care charges among patients with severe sepsis.Design: Retrospective cohort study.Setting: Large, integrated, geographically diverse, U.S. health-insurance claims database covering three million lives annually.Patients: All persons with bacterial or fungal infections and acute organ dysfunction (severe sepsis) who were hospitalized between January 1, 1991, and August 31, 2000.Interventions: None.Measurements and Main Results: All patients were followed from the date of hospitalization with severe sepsis (index admission) to August 31, 2000, disenrollment from the health plan, or death, whichever occurred first. Measures of interest included mortality and medical care charges and were estimated for the index admission, the 90- and 180-day periods following the index admission, and annually thereafter (up to 5 yrs), using techniques of survival analysis. A total of 16,019 patients were identified who met study entrance criteria. Most patients (81.2%) were greater than or equal to65 yrs of age; 53.4% were men. Mortality was 21.2% for the index admission, 51.4% at 1yr, and 74.2% at 5 yrs. Mean cumulative total medical care charges were $44,600 for the index admission, $78,500 at 1yr, and $118,800 at 5 yrs. Hospitalization accounted for the largest component of total medical care charges.Conclusions: Mortality and economic costs are high in patients with severe sepsis, during the period of acute illness as well as subsequently.