Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study
Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study
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DOI：
10.1007/s00134-016-4504-3
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发表时间：
2016-12-01
影响因子：
38.9
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中科院分区：
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为了评估德国重症监护病房(ICU)严重败血症和感染性休克的发病率、点患病率和预后。在一项前瞻性、多中心、纵向观察研究中，纳入了2013年11月4日0：00已经在ICU的所有患者以及在2013年11月4日0：00至2013年12月1日2359小时之间进入参与ICU的所有患者。这些患者在ICU期间接受了严重脓毒症或感染性休克的随访(败血症-1定义)。共有来自95家德国医院的133个ICU的11,883名患者参与了这项研究，其中1503人(12.6%)被诊断为严重败血症或感染性休克。医院感染860例(57.2%)。严重败血症或感染性休克的发生率为11.64(95%可信区间10.51~12.86)/1000天。重症感染/感染性休克患者的ICU病死率为34.3%，而非脓毒症患者为6%。严重脓毒症或感染性休克患者的总住院死亡率为40.4%。根据新的脓毒症-3定义对败血症休克患者进行分类，显示出更高的ICU和住院死亡率(44.3%和50.9%)。严重败血症和败血症休克仍然是与高住院死亡率相关的常见综合征。医院感染在脓毒症的发生发展中起重要作用。本研究为脓毒症流行病学监测提供了一种实用、经济、可行的方法。新的败血症-3定义的实施可能会对未来的流行病学数据产生重大影响。
To estimate the incidence density, point prevalence and outcome of severe sepsis and septic shock in German intensive care units (ICUs).In a prospective, multicentre, longitudinal observational study, all patients already on the ICU at 0:00 on 4 November 2013 and all patients admitted to a participating ICU between 0:00 on 4 November 2013 and 2359 hours on 1 December 2013 were included. The patients were followed up for the occurrence of severe sepsis or septic shock (SEPSIS-1 definitions) during their ICU stay.A total of 11,883 patients from 133 ICUs at 95 German hospitals were included in the study, of whom 1503 (12.6 %) were diagnosed with severe sepsis or septic shock. In 860 cases (57.2 %) the infections were of nosocomial origin. The point prevalence was 17.9 % (95 % CI 16.3-19.7).The calculated incidence rate of severe sepsis or septic shock was 11.64 (95 % CI 10.51-12.86) per 1000 ICU days. ICU mortality in patients with severe sepsis/septic shock was 34.3 %, compared with 6 % in those without sepsis. Total hospital mortality of patients with severe sepsis or septic shock was 40.4 %. Classification of the septic shock patients using the new SEPSIS-3 definitions showed higher ICU and hospital mortality (44.3 and 50.9 %).Severe sepsis and septic shock continue to be a frequent syndrome associated with high hospital mortality. Nosocomial infections play a major role in the development of sepsis. This study presents a pragmatic, affordable and feasible method for the surveillance of sepsis epidemiology. Implementation of the new SEPSIS-3 definitions may have a major effect on future epidemiological data.