Evidence for a causal link between sepsis and long-term mortality: a systematic review of epidemiologic studies.
Evidence for a causal link between sepsis and long-term mortality: a systematic review of epidemiologic studies.
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DOI：
10.1186/s13054-016-1276-7
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发表时间：
2016-04-13
期刊：
影响因子：
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通讯作者：
Rubenfeld GD
中科院分区：
文献类型：
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作者：
Shankar-Hari M;Ambler M;Mahalingasivam V;Jones A;Rowan K;Rubenfeld GD
除了急性住院死亡率外，脓毒症还与出院后较高的死亡风险相关。我们通过系统地评估现有文献的关联强度、偏倚和解决混杂因素的技术，评估了支持脓毒症与出院后死亡率之间因果关系的流行病学证据的强度。我们使用以下“mp”术语、MESH 标题及其组合搜索了 Medline 和 Embase：败血症、败血性休克、败血症、结果。其中包括自 1992 年以来发表的研究，其中可以计算急性脓毒症成年幸存者的急性期后一年死亡率。两位作者独立选择研究并使用预定义的标准和数据提取表格提取数据，以评估偏倚、混杂因素和因果关系的风险。一年累积死亡率与急性死亡率之间的比例差被定义为急性期后死亡率。根据脓毒症定义类别进行荟萃分析，以急性期死亡率作为主要结局。文献检索共找到 11,156 条记录，其中 59 项研究符合我们的纳入标准，43 项研究报告了急性后死亡率。根据随机效应荟萃分析，在因脓毒症入院后幸存的患者中，急性期后死亡率为 16.1%（95% CI 14.1, 18.1%），具有显着异质性 (p<0.001)。在报告非脓毒症对照组比较的研究中，脓毒症并不总是与较高的急性后死亡率风险比相关。与一般人群相比，与脓毒症相关的额外危险最大。据报道，年龄较大、男性和合并症的存在是脓毒症幸存者急性期死亡的独立预测因素，这对因果关系提出了挑战。急性后死亡率的敏感性分析与初步分析一致。脓毒症与急性后死亡率之间因果关系的流行病学标准并未得到一致观察。需要利用最近的患者水平数据进行额外的流行病学研究，以解决病前轨迹、混杂因素和不同的对照组，以估计脓毒症可归因的额外风险和可修改的风险因素，以设计干预试验。本文的在线版本 (doi:10.1186/s13054-016-1276-7) 包含补充材料，可供授权用户使用。
In addition to acute hospital mortality, sepsis is associated with higher risk of death following hospital discharge. We assessed the strength of epidemiological evidence supporting a causal link between sepsis and mortality after hospital discharge by systematically evaluating the available literature for strength of association, bias, and techniques to address confounding. We searched Medline and Embase using the following ‘mp’ terms, MESH headings and combinations thereof - sepsis, septic shock, septicemia, outcome. Studies published since 1992 where one-year post-acute mortality in adult survivors of acute sepsis could be calculated were included. Two authors independently selected studies and extracted data using predefined criteria and data extraction forms to assess risk of bias, confounding, and causality. The difference in proportion between cumulative one-year mortality and acute mortality was defined as post-acute mortality. Meta-analysis was done by sepsis definition categories with post-acute mortality as the primary outcome. The literature search identified 11,156 records, of which 59 studies met our inclusion criteria and 43 studies reported post-acute mortality. In patients who survived an index sepsis admission, the post-acute mortality was 16.1 % (95 % CI 14.1, 18.1 %) with significant heterogeneity (p < 0.001), on random effects meta-analysis. In studies reporting non-sepsis control arm comparisons, sepsis was not consistently associated with a higher hazard ratio for post-acute mortality. The additional hazard associated with sepsis was greatest when compared to the general population. Older age, male sex, and presence of comorbidities were commonly reported independent predictors of post-acute mortality in sepsis survivors, challenging the causality relationship. Sensitivity analyses for post-acute mortality were consistent with primary analysis. Epidemiologic criteria for a causal relationship between sepsis and post-acute mortality were not consistently observed. Additional epidemiologic studies with recent patient level data that address the pre-illness trajectory, confounding, and varying control groups are needed to estimate sepsis-attributable additional risk and modifiable risk factors to design interventional trials. The online version of this article (doi:10.1186/s13054-016-1276-7) contains supplementary material, which is available to authorized users.