Nationwide Trends of Severe Sepsis in the 21st Century (2000-2007)-猫眼课题宝

DOI：

10.1378/chest.11-0352

发表时间：

2011-11-01

期刊：

CHEST

影响因子：

9.6

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Kumar, Gagan;Kumar, Nilay;Nanchal, Rahul

背景：严重脓毒症很常见，通常是致命的。不断扩大的循证治疗手段改善了这种疾病患者的预后。然而，现有的国家对严重脓毒症的频率和结果的估计是在许多最近的治疗进展之前做出的。因此，研究这种疾病在美国老龄化人口中的结果是很重要的。方法：我们使用医疗保健成本和利用项目的全国住院样本(NIS)来估计2000至2007年间严重脓毒症住院的频率和结果。我们根据国际疾病分类，第九版，临床修改代码确定了严重脓毒症的住院情况，表明存在脓毒症和器官系统衰竭。使用NIS的权重，我们估计了每年因严重脓毒症而住院的人数。我们将这些数据与人口普查数据相结合，以确定每10万人中严重脓毒症住院的数量。我们使用出院状态来确定住院死亡率，并在调整了人口统计学、器官系统衰竭数量和合并疾病的存在后，比较了2000年和2007年的死亡率。结果：每10万人中的严重脓毒症住院人数从2000年的143人增加到2007年的343人。入院期间器官系统衰竭的平均数量从1.6例增加到1.9例(P&lt；.001)。平均住院天数由17.3天降至14.9天。死亡率从39%下降到27%。然而，与2000年相比，2007年因长期护理机构出院而结束的住院人数更多(35%比27%，P&lt；.001)。结论：严重脓毒症住院人数的增加和死亡率的下降有助于更多的人存活到出院。重要的是，这导致更多的幸存者被送往熟练的护理设施和接受家庭护理的家庭。对这一现象给予更多关注是有必要的。《胸部》2011；140(5)：1223-1231

Background: Severe sepsis is common and often fatal. The expanding armamentarium of evidence-based therapies has improved the outcomes of persons with this disease. However, the existing national estimates of the frequency and outcomes of severe sepsis were made before many of the recent therapeutic advances. Therefore, it is important to study the outcomes of this disease in an aging US population with rising comorbidities.Methods: We used the Healthcare Costs and Utilization Project's Nationwide Inpatient Sample (NIS) to estimate the frequency and outcomes of severe sepsis hospitalizations between 2000 and 2007. We identified hospitalizations for severe sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating the presence of sepsis and organ system failure. Using weights from NIS, we estimated the number of hospitalizations for severe sepsis in each year. We combined these with census data to determine the number of severe sepsis hospitalizations per 100,000 persons. We used discharge status to identify in-hospital mortality and compared mortality rates in 2000 with those in 2007 after adjusting for demographics, number of organ systems failing, and presence of comorbid conditions.Results: The number of severe sepsis hospitalizations per 100,000 persons increased from 143 in 2000 to 343 in 2007. The mean number of organ system failures during admission increased from 1.6 to 1.9 (P < .001). The mean length of hospital stay decreased from 17.3 to 14.9 days. The mortality rate decreased from 39% to 27%. However, more admissions ended with discharge to a long-term care facility in 2007 than in 2000 (35% vs 27%, P < .001).Conclusions: An increasing number of admissions for severe sepsis combined with declining mortality rates contribute to more individuals surviving to hospital discharge. Importantly, this leads to more survivors being discharged to skilled nursing facilities and home with in-home care. Increased attention to this phenomenon is warranted. CHEST 2011;140(5):1223-1231

Nationwide Trends of Severe Sepsis in the 21st Century (2000-2007)

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