The association of sepsis syndrome and organ dysfunction with mortality in emergency department patients with suspected infection
The association of sepsis syndrome and organ dysfunction with mortality in emergency department patients with suspected infection
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DOI：
10.1016/j.annemergmed.2006.07.007
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发表时间：
2006-11-01
影响因子：
6.2
通讯作者：
Talmor, Daniel
中科院分区：
文献类型：
--
作者：
Shapiro, Nathan;Howell, Michael D.;Talmor, Daniel
研究目的：重症监护界使用标准标准来定义脓毒症综合征和器官功能障碍已超过 15 年；然而，这些标准在急诊科 (ED) 环境中并未得到很好的验证。我们的急诊科入院患者群体的研究目标是确定脓毒症综合征的患病率，量化与脓毒症综合征相关的院内死亡率和 1 年生存率，并评估与器官功能障碍相关的院内生存率和 1 年生存率。 方法：这是一项 2000 年 2 月 1 日至 2001 年 2 月 1 日在一所城市大学进行的前瞻性观察性队列研究 每年就诊人数达 50,000 人次的医院急诊室。共有 3,102 名（符合条件的 96%）连续成年患者（18 岁或以上）疑似感染（根据临床决定进行血培养）入组。对患者进行全身炎症反应综合征（SIRS）（2个或更多炎症反应指标）、脓毒症（SIRS加疑似感染）、严重脓毒症（脓毒症加器官功能障碍）、脓毒症休克（脓毒症加初始液体挑战难治性低血压）和急性功能障碍器官数量的筛查。主要结局指标是住院死亡率和 1 年死亡率。结果：总体住院死亡率为 4.1%，1 年死亡率为 22%。院内死亡率为疑似感染但无SIRS 2.1%，败血症1.3%，严重败血症9.2%，败血性休克28%。与无 SIRS 的疑似感染相比，调整后的院内死亡风险为严重脓毒症（比值比 (OR) 4.0；95% 置信区间 [CI] 2.6 至 6.3）和脓毒性休克（OR 13.8；95% CI 6.6 至 29）。严重脓毒症（OR 2.2；95% CI 1.8 至 2.6）和脓毒性休克（OR 3.5；95% CI 2.3 至 5.3）也预测 1 年死亡率。仅 SIRS 标准的存在对于任一终点都没有预后价值。每增加一个器官功能障碍，调整后的 1 年死亡风险就会增加 82%（脉率：1.82，95% CI 1.7 至 2.0）。 结论：立即识别疑似感染的 ED 患者的急性器官功能障碍可能有助于选择短期和长期死亡风险增加的患者。 SIRS 标准没有提供额外的 预后价值，而每增加一个器官功能障碍就会增加 1 年死亡风险。
Study objective: The critical care community has used standard criteria for defining the sepsis syndromes and organ dysfunction for more than 15 years; however, these criteria are not well validated in the emergency department (ED) setting. The study objectives in our ED population of patients admitted to the hospital are to determine the prevalence of the sepsis syndromes, quantify inhospital mortality and 1-year survival associated with the sepsis syndromes, and assess the inhospital and 1-year survival associated with organ dysfunctions.Methods: This was a prospective, observational, cohort study from February 1, 2000, to February 1, 2001 in an urban university hospital ED with 50,000 annual visits. There were 3,102 (96% of eligible) consecutive adult patients (aged 18 years or older) with suspected infection (as indicated by the clinical decision to obtain a blood culture) who were enrolled. Patients were screened for systemic inflammatory response syndrome (SIRS) (2 or more indicators of inflammatory response), sepsis (SIRS plus suspected infection), severe sepsis (sepsis plus organ dysfunction), septic shock (sepsis plus hypotension refractory to an initial fluid challenge), and number of organs with acute dysfunction. Main outcome measure was inhospital and 1-year mortality.Results: Overall inhospital mortality was 4.1% and 1-year mortality was 22%. The inhospital mortality rates were suspected infection without SIRS 2.1%, sepsis 1.3%, severe sepsis 9.2%, and septic shock 28%. Compared to suspected infection without SIRS, adjusted risks of inhospital mortality were severe sepsis (odds ratio (OR] 4.0; 95% confidence interval [CI] 2.6 to 6.3) and septic shock (OR 13.8; 95% CI 6.6 to 29). Severe sepsis (OR 2.2; 95% Cl 1.8 to 2.6) and septic shock (OR 3.5; 95% CI 2.3 to 5.3) also predicted 1-year mortality. The presence of SIRS criteria alone had no prognostic value for either endpoint. Each additional organ dysfunction increased the adjusted 1-year mortality hazard by 82% (pulse rate: 1.82, 95% CI 1.7 to 2.0).Conclusion: Immediate identification of acute organ dysfunction in ED patients with suspected infection may help select patients at increased short- and long-term mortality risk. SIRS criteria offered no additional prognostic value, whereas each additional organ dysfunction increased the 1-year mortality risk.