Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study.
Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study.
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DOI：
10.1016/s1473-3099(17)30117-2
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Wang HE
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文献类型：
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作者：
Donnelly JP;Safford MM;Shapiro NI;Baddley JW;Wang HE
脓毒症的第三次国际共识定义（脓毒症-3）提出了对感染患者进行分类的临床标准。这些分类的事件发生率和长期结局未知。我们使用入选卒中地理和种族差异原因（REGARDS）队列的30，239名年龄≥45岁的美国受试者的数据进行了回顾性分析。我们使用三种分类确定了2003-2012年的住院情况：感染伴全身炎症反应综合征（SIRS）、脓毒症相关器官衰竭评估评分（SOFA）升高或“快速”SOFA（qSOFA）评分升高。我们检查了研究期间的发病率、住院死亡率和1年死亡率，提供了估计值和95%置信区间（CI）。在2,593例感染事件中，有1,526例败血症-SIRS，1,080例败血症-SOFA和378例败血症-qSOFA事件。脓毒症-SIRS事件的发生率最高（8.2/1000人-年; 95% CI 7.8-8.7），其次是脓毒症-SOFA（5.8; CI 5.4-6.1）和脓毒症-qSOFA（2.0; CI 1.8-2.2）。脓毒症-qSOFA（67/295; 22.7%）的住院死亡率高于脓毒症-SOFA（125/960; 13.0%）和脓毒症-SIRS（128/1，392; 9.2%）。与脓毒症-SOFA（22.6; CI 19.2-26.6）和脓毒症-SIRS（14.7; CI 12.5-17.2）相比，脓毒症-qSOFA（29.4/100人-年; CI 22.3-38.7）的出院后1年死亡率也最高。检查的分类确定了不同的发病率和死亡率。我们的研究结果支持使用脓毒症-SOFA和脓毒症-qSOFA分类识别感染患者的不良结局风险升高。我们还展示了如何将这些分类用于未来的流行病学评估和感染患者的研究。国家护理研究所（R 01-NR 012726）、国家研究资源中心（UL 1-RR 025777）和国家神经疾病和中风研究所（U 01-NS 041588）。JPD持有医疗保健研究和质量机构博士前奖学金（T32-HS 013852）。MMS得到了国家心肺血液研究所（K24-HL 111154）的指导奖的支持。
The Third International Consensus Definitions for Sepsis (Sepsis-3) present clinical criteria for classifying infection patients. Event incidence and long-term outcomes across these classifications are unknown. We conducted a retrospective analysis using data from 30,239 US participants aged ≥45 years enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We identified hospitalizations over 2003–2012 using three classifications: infection with systemic inflammatory response syndrome (SIRS), elevated sepsis-related organ failure assessment score (SOFA), or elevated “quick” SOFA (qSOFA) score. We examined incidence over the study period, in-hospital mortality, and one-year mortality, providing estimates and 95% confidence intervals (CIs). Among 2,593 infection events, there were 1,526 sepsis-SIRS, 1,080 sepsis-SOFA, and 378 sepsis-qSOFA events. Sepsis-SIRS events had the highest incidence (8.2 per 1,000 person-years; 95% CI 7.8–8.7), followed by sepsis-SOFA (5.8; CI 5.4–6.1) and sepsis-qSOFA (2.0; CI 1.8–2.2). In-hospital mortality was higher for sepsis-qSOFA (67/295; 22.7%) than sepsis-SOFA (125/960; 13.0%) and sepsis-SIRS (128/1,392; 9.2%). One-year mortality post-discharge was also highest for sepsis-qSOFA (29.4 per 100 person-years; CI 22.3–38.7) compared to sepsis-SOFA (22.6; CI 19.2–26.6) and sepsis-SIRS (14.7; CI 12.5–17.2). The examined classifications identified different incidence and mortality. Our findings support the use of the sepsis-SOFA and sepsis-qSOFA classifications for identification of infection patients at elevated risk of poor outcomes. We also demonstrate how these classifications could be used in future epidemiological assessments and studies of patients with infection. National Institute for Nursing Research (R01-NR012726), National Center for Research Resources (UL1-RR025777), and National Institute of Neurological Disorders and Stroke (U01-NS041588). JPD held an Agency for Healthcare Research and Quality predoctoral fellowship (T32-HS013852). MMS was supported by a mentoring award from the National Heart, Lung and Blood Institute (K24-HL111154).