Sepsis in European intensive care units: Results of the SOAP study
Sepsis in European intensive care units: Results of the SOAP study
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DOI：
10.1097/01.ccm.0000194725.48928.3a
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发表时间：
2006-02-01
影响因子：
8.8
通讯作者：
Payen, D
中科院分区：
文献类型：
--
作者：
Vincent, JL;Sakr, Y;Payen, D
目的：为了更好地了解欧洲重症监护病房中脓毒症的发病率和危重病人的特点。设计：队列、多中心、观察性研究。设置：24个欧洲国家的198个重症监护病房。患者：2002年5月1日至15日期间所有新入院的成人重症监护病房。干预。无。测量和主要结果：前瞻性收集人口学数据、并存疾病、临床和实验室数据。对患者进行随访，直到死亡，直到出院，或60天。在3,147名成年患者中，中位年龄为的患者中，有1,177人(37.4%)患有败血症；其中777人(24.7%)在入院时发生了败血症。在败血症患者中，肺部是最常见的感染部位(68%)，其次是腹部(22%)。脓毒症患者中有60%的患者培养阳性。最常见的细菌是金黄色葡萄球菌(30%，包括14%的耐甲氧西林细菌)、假单胞菌(14%)和大肠埃希菌(13%)。假单胞菌是唯一与死亡率增加独立相关的微生物。有脓毒症的患者比无脓毒症的患者有更严重的器官功能障碍，更长的重症监护病房和住院时间，以及更高的死亡率。在脓毒症患者中，年龄、液体正平衡、感染性休克、癌症和入院是影响重症监护病房死亡率的重要预后变量。不同国家之间有相当大的差异，在这些国家中，脓毒症的频率和重症监护病房死亡率之间存在很强的相关性。这项大型的泛欧洲研究记录了重症患者中脓毒症的高发生率，并显示了不同国家脓毒症患者的比例与重症监护病房死亡率之间的密切关系。除了年龄，积极的液体平衡是死亡的最强烈的预后因素之一。重症监护病房获得性脓毒症患者的预后更差，尽管重症监护病房入院时的严重程度评分相似。
Objective: To better define the incidence of sepsis and the characteristics of critically ill patients in European intensive care units.Design: Cohort, multiple-center, observational study.Setting: One hundred and ninety-eight intensive care units in 24 European countries.Patients: All new adult admissions to a participating intensive care unit between May 1 and 15, 2002.Interventions. None.Measurements and Main Results: Demographic data, comorbid diseases, and clinical and laboratory data were collected prospectively. Patients were followed up until death, until hospital discharge, or for 60 days. Of 3,147 adult patients, with a median age of 64 yrs, 1,177 (37.4%) had sepsis; 777 (24.7%) of these patients had sepsis on admission. In patients with sepsis, the lung was the most common site of infection (68%), followed by the abdomen (22%). Cultures were positive in 60% of the patients with sepsis. The most common organisms were Staphylococcus aureus (30%, including 14% methicillin-resistant), Pseudomonas species (14%), and Escherichia coli (13%). Pseudomonas species was the only microorganism independently associated with increased mortality rates. Patients with sepsis had more severe organ dysfunction, longer intensive care unit and hospital lengths of stay, and higher mortality rate than patients without sepsis. In patients with sepsis, age, positive fluid balance, septic shock, cancer, and medical admission were the important prognostic variables for intensive care unit mortality. There was considerable variation between countries, with a strong correlation between the frequency of sepsis and the intensive care unit mortality rates in each of these countries.Conclusions. This large pan-European study documents the high frequency of sepsis in critically ill patients and shows a close relationship between the proportion of patients with sepsis and the intensive care unit mortality in the various countries. In addition to age, a positive fluid balance was among the strongest prognostic factors for death. Patients with intensive care unit acquired sepsis have a worse outcome despite similar severity scores on intensive care unit admission.