Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study.
Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study.
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DOI：
10.1186/cc7157
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Grupo de Estudios y Análisis en Cuidados Intensivos
中科院分区：
文献类型：
--
作者：
Blanco J;Muriel-Bombín A;Sagredo V;Taboada F;Gandía F;Tamayo L;Collado J;García-Labattut A;Carriedo D;Valledor M;De Frutos M;López MJ;Caballero A;Guerra J;Alvarez B;Mayo A;Villar J;Grupo de Estudios y Análisis en Cuidados Intensivos
脓毒症是进入非心脏病重症监护病房（ICU）的主要原因，也是ICU患者死亡的第二大原因。我们提出了第一个广泛的数据集的流行病学严重脓毒症治疗ICU在西班牙。我们在2002年进行了一项前瞻性、观察性、多中心的队列研究，为期两个月。我们的目的是确定西班牙特定地区ICU中成人严重脓毒症的发病率，以确定早期（48小时）ICU和医院死亡率，以及与死亡风险相关的因素。共有4，317例患者入院，2，619例患者符合研究条件;其中311例（11.9%）至少发生1次严重脓毒症，记录了324例（12.4%）严重脓毒症。人群的估计累积发病率为每年每100，000名居民中有25例重症脓毒症在ICU接受治疗。入院时的平均逻辑器官功能障碍系统（LODS）为6.3;第一天的平均脓毒症相关器官衰竭评估（SOFA）评分为9.6。78.1%的患者在诊断时存在两个或两个以上器官衰竭。在209例败血症（64.5%）中达到了感染的微生物诊断，最常见的临床诊断是肺炎（42.8%）。共有169名患者（54.3%）死于医院，其中150名（48.2%）死于ICU。48 h内死亡率为14.8%。与早期死亡相关的因素是诊断时的血液学衰竭和肝功能衰竭、ICU入院前的感染和入院时的LODS总评分。与院内死亡相关的因素包括年龄、慢性酒精滥用、McCabe评分增加、入院时LODS较高、ΔSOFA 3-1（定义为第3天和第1天SOFA总评分的差异）以及前15天SOFA评分曲线下面积的差异。我们发现重症监护室中严重脓毒症的发生率高，ICU和医院死亡率高。诊断时多器官功能衰竭的高患病率和前48小时的高死亡率表明诊断、初始复苏和/或开始适当的抗生素治疗的延迟。
Sepsis is a leading cause of admission to non-cardiological intensive care units (ICUs) and the second leading cause of death among ICU patients. We present the first extensive dataset on the epidemiology of severe sepsis treated in ICUs in Spain. We conducted a prospective, observational, multicentre cohort study, carried out over two 3-month periods in 2002. Our aims were to determine the incidence of severe sepsis among adults in ICUs in a specific area in Spain, to determine the early (48 h) ICU and hospital mortality rates, as well as factors associated with the risk of death. A total of 4,317 patients were admitted and 2,619 patients were eligible for the study; 311 (11.9%) of these presented at least 1 episode of severe sepsis, and 324 (12.4%) episodes of severe sepsis were recorded. The estimated accumulated incidence for the population was 25 cases of severe sepsis attended in ICUs per 100,000 inhabitants per year. The mean logistic organ dysfunction system (LODS) upon admission was 6.3; the mean sepsis-related organ failure assessment (SOFA) score on the first day was 9.6. Two or more organ failures were present at diagnosis in 78.1% of the patients. A microbiological diagnosis of the infection was reached in 209 episodes of sepsis (64.5%) and the most common clinical diagnosis was pneumonia (42.8%). A total of 169 patients (54.3%) died in hospital, 150 (48.2%) of these in the ICU. The mortality in the first 48 h was 14.8%. Factors associated with early death were haematological failure and liver failure at diagnosis, acquisition of the infection prior to ICU admission, and total LODS score on admission. Factors associated with death in the hospital were age, chronic alcohol abuse, increased McCabe score, higher LODS on admission, ΔSOFA 3-1 (defined as the difference in the total SOFA scores on day 3 and on day 1), and the difference of the area under the curve of the SOFA score throughout the first 15 days. We found a high incidence of severe sepsis attended in the ICU and high ICU and hospital mortality rates. The high prevalence of multiple organ failure at diagnosis and the high mortality in the first 48 h suggests delays in diagnosis, in initial resuscitation, and/or in initiating appropriate antibiotic treatment.
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影响因子：
120.7
作者：
BRUNBUISSON, C;DOYON, F;REGNIER, B
通讯作者：
REGNIER, B
影响因子：
8.8
作者：
BARRIERE, SL;LOWRY, SF
通讯作者：
LOWRY, SF
影响因子：
8.8
作者：
Vincent, JL;Sakr, Y;Payen, D
通讯作者：
Payen, D
影响因子：
--
作者：
MCCABE, WR;JACKSON, GG
通讯作者：
JACKSON, GG
影响因子：
120.7
作者：
RANGELFRAUSTO, MS;PITTET, D;WENZEL, RP
通讯作者：
WENZEL, RP