Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study
Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study
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DOI：
10.1016/s1473-3099(12)70239-6
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发表时间：
2012-12-01
影响因子：
56.3
通讯作者：
Dellinger, R. Phillip
中科院分区：
文献类型：
--
作者：
Levy, Mitchell M.;Artigas, Antonio;Dellinger, R. Phillip
背景严重败血症和感染性休克的死亡率因大陆、国家和地区而异。我们的目标是使用存活败血症运动(SSC)的数据来比较美国和欧洲严重脓毒症和感染性休克患者的护理模式和预后。方法在欧洲和美国的200多个地点引入SSC。所有在急诊科或医院病房确诊为严重脓毒症和感染性休克并住进重症监护病房(ICU)的患者以及ICU中有脓毒症的患者都被录入SSC数据库。从2005年1月开始到2010年1月，以至少20名患者和3个月的患者登记为单位输入的患者被纳入这一分析。队列中的患者仅限于在每个地点的前4年进入的患者。我们使用随机效应Logistic回归来估计欧洲相对于美国的住院死亡率优势比(OR)。我们用随机效应线性回归分析了住院时间和ICU时间与地理区域的关系，发现队列中有25375名患者。美国包括107个地点，18766名患者(74%)，欧洲包括79个医院地点，6609名患者(26%)。在美国，12218人(65.1%)是从急诊科住进ICU，而在欧洲，3405人(51.5%)是从病房住进ICU。欧洲患者在ICU入院前住院天数的中位数较美国长(1.0天比0.1天，相差0.9天，95%可信区间0.8~0.9)。欧洲的原始住院死亡率高于美国(41.1%比28.3%，差异12.8，95%可信区间11.5-14.7)。欧洲患者在ICU的中位住院时间(7.8比4.2天，3.6，3.3-3.7)和住院时间(22.8比10.5天，12.3，11.9-12.8)均长于美国。欧洲的调整死亡率并不显著高于美国(32.3%vs31.3%，1，-1.7to3.7，p=0.468)。美国对脓毒症复苏包所有适用要素的完全依从性高于欧洲(21.6%比18.4%，3.2，2.2-4.4)。解释未调整死亡率的显著差异以及这种差异随着严重程度调整而消失的事实提出了重要的问题，即与美国相比，欧洲重症监护方法的效果如何。ICU床位可获得性对严重败血症和感染性休克患者预后的影响需要进一步研究。
Background Mortality from severe sepsis and septic shock differs across continents, countries, and regions. We aimed to use data from the Surviving Sepsis Campaign (SSC) to compare models of care and outcomes for patients with severe sepsis and septic shock in the USA and Europe.Methods The SSC was introduced into more than 200 sites in Europe and the USA. All patients identified with severe sepsis and septic shock in emergency departments or hospital wards and admitted to intensive care units (ICUs), and those with sepsis in ICUs were entered into the SSC database. Patients entered into the database from its launch in January, 2005, through January, 2010, in units with at least 20 patients and 3 months of enrolment of patients were included in this analysis. Patients included in the cohort were limited to those entered in the first 4 years at every site. We used random-effects logistic regression to estimate the hospital mortality odds ratio (OR) for Europe relative to the USA. We used random-effects linear regression to find the relation between lengths of stay in hospital and ICU and geographic region.Findings 25 375 patients were included in the cohort. The USA included 107 sites with 18 766 (74%) patients, and Europe included 79 hospital sites with 6609 (26%) patients. In the USA, 12 218 (65.1%) were admitted to the ICU from the emergency department whereas in Europe, 3405 (51.5%) were admitted from the wards. The median stay on the hospital wards before ICU admission was longer in Europe than in the USA (1.0 vs 0.1 days, difference 0.9, 95% CI 0.8-0.9). Raw hospital mortality was higher in Europe than in the USA (41.1% vs 28.3%, difference 12.8, 95% CI 11.5-14.7). The median length of stay in ICU (7.8 vs 4.2 days, 3.6, 3.3-3.7) and hospital (22.8 vs 10.5 days, 12.3, 11.9-12.8) was longer in Europe than in the USA. Adjusted mortality in Europe was not significantly higher than that in the USA (32.3% vs 31.3%, 1.0, -1.7 to 3.7, p=0.468). Complete compliance with all applicable elements of the sepsis resuscitation bundle was higher in the USA than in Europe (21.6% vs 18.4%, 3.2, 2.2-4.4).Interpretation The significant difference in unadjusted mortality and the fact that this difference disappears with severity adjustment raise important questions about the effect of the approach to critical care in Europe compared with that in the USA. The effect of ICU bed availability on outcomes in patients with severe sepsis and septic shock requires further investigation.