One-year mortality of bloodstream infection-associated sepsis and septic shock among patients presenting to a regional critical care system
One-year mortality of bloodstream infection-associated sepsis and septic shock among patients presenting to a regional critical care system
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DOI：
10.1007/s00134-004-2544-6
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发表时间：
2005-02-01
影响因子：
38.9
通讯作者：
Fick, GH
中科院分区：
文献类型：
--
作者：
Laupland, KB;Zygun, DA;Fick, GH
目的：在未经选择的危重人群中，与败血症和败血性休克相关的长期死亡率结果尚未明确。本研究调查了入住重症监护病房 (ICU) 时血流感染 (BSI) 相关败血症和败血性休克对区域重症监护系统患者 1 年死亡率的影响。设计和设置：1999 年 7 月 1 日至 2002 年 3 月 31 日期间卡尔加里卫生区所有成人多学科和心血管 ICU（人口约 100 万）中基于人群的初始队列。患者和参与者：至少入住过 1 个 ICU 入住 CHR ICU 的成人（大于或等于 18 岁；n=4,845）。结果：251 名 (5%) 患者在入住 ICU 时患有 BSI 相关脓毒症，其中 159 名患者还患有感染性休克。 28 天、90 天和 1 年死亡率总体分别为 18%、21% 和 24%：BSI 相关脓毒症（无休克）的死亡率分别为 23%、30% 和 36%，有休克的死亡率分别为 51%、57% 和 61%。手术诊断、BSI 相关脓毒症和年龄增加与晚期（28 天至 1 年）死亡率独立相关，而较高的 APACHE II 和 TISS 评分与 Logistic 回归分析中的几率降低相关。结论：BSI 相关败血症和败血性休克与 28 天至 1 年或更长时间后持续存在的死亡风险增加相关。超过 28 天的随访时间可以更好地确定与这些综合征相关的疾病负担。
Objective: The long-term mortality outcome associated with sepsis and septic shock has not been well defined in a nonselected critically ill population. This study investigated the occurrence and the role of bloodstream infection (BSI) associated sepsis and septic shock at time of intensive care unit (ICU) admission on the 1-year mortality of patients admitted to a regional critical care system. Design and Settings: Population-based inception cohort in all adult multidisciplinary and cardiovascular ICUs in the Calgary Health Region (population approx. 1 million) between 1 July 1999 and 31 March 2002. Patients and Participants: Adults (greater than or equal to18 years; n=4,845) who had at least one ICU admission to CHR ICUs. Results: In 251 (5%) patients there was BSI-associated sepsis at presentation to ICU, and 159 of these also had septic shock. The 28-day, 90-day, and 1-year mortality rates overall were 18%, 21%, and 24%: 23%, 30%, and 36% for BSI-associated sepsis without shock, and 51%, 57%, and 61% with shock, respectively. Surgical diagnosis, BSI-associated sepsis, and increasing age were independently associated with late (28-day to 1-year) mortality whereas higher APACHE II and TISS scores were associated with reduced odds in logistic regression analysis. Conclusions: BSI-associated sepsis and septic shock are associated with increased risk of mortality persisting after 28-days up to 1 year or more. Follow-up duration beyond 28 days better defines the burden of illness associated with these syndromes.