Maternal Sepsis Mortality and Morbidity During Hospitalization for Delivery: Temporal Trends and Independent Associations for Severe Sepsis
Maternal Sepsis Mortality and Morbidity During Hospitalization for Delivery: Temporal Trends and Independent Associations for Severe Sepsis
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DOI：
10.1213/ane.0b013e3182a009c3
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发表时间：
2013-10-01
影响因子：
5.7
通讯作者：
Mhyre, Jill M.
中科院分区：
文献类型：
--
作者：
Bauer, Melissa E.;Bateman, Brian T.;Mhyre, Jill M.
背景：败血症目前是英国孕产妇直接死亡的主要原因。在这项研究中，我们的目标是确定美国分娩住院期间严重脓毒症的频率、时间趋势和独立相关性。方法：数据来自1998至2008年的全国住院患者样本。严重脓毒症的存在由适当的国际疾病分类，第九次修订，临床修改代码确定。结果：在估计的44,999,260例住院分娩中，败血症合并1：3333(95%可信区间，1：3151-1：3540)分娩，严重败血症合并1：10,823(95%可信区间，1：10,000-1：11,792)分娩，败血症相关死亡合并1：105,263(95%可信区间，1：83,333-1：131,579)分娩。虽然脓毒症的总体频率稳定(P=0.001.95)，但在研究期间，严重脓毒症和脓毒症相关死亡的风险分别增加(P<；0.0 5)和(P=0.0 2)。严重脓毒症的独立关联因素包括充血性心力衰竭、慢性肝病、慢性肾脏疾病、系统性红斑狼疮和抢救环扎术。结论：在美国，孕产妇严重败血症和败血症相关死亡病例正在增加。严重脓毒症通常在缺乏公认的危险因素的情况下发生，并强调了发展护理系统的必要性，以提高整个人群对疾病检测的敏感性。医生应加强对充血性心力衰竭、慢性肝病、慢性肾脏疾病和系统性红斑狼疮患者的监测，并在出现脓毒症迹象时及早治疗。
BACKGROUND: Sepsis is currently the leading cause of direct maternal death in the United Kingdom. In this study, we aimed to determine frequency, temporal trends, and independent associations for severe sepsis during hospitalization for delivery in the United States.METHODS: Data were obtained from the Nationwide Inpatient Sample for the years 1998 through 2008. The presence of severe sepsis was identified by the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Logistic regression analysis was used to assess temporal trends for sepsis, severe sepsis, and sepsis-related death and also to identify independent associations of severe sepsis.RESULTS: Of an estimated 44,999,260 hospitalizations for delivery, sepsis complicated 1: 3333 (95% confidence interval [CI], 1: 3151-1: 3540) deliveries, severe sepsis complicated 1: 10,823 (95% CI, 1: 10,000-1: 11,792) deliveries, and sepsis-related death complicated 1: 105,263 (95% CI, 1: 83,333-1: 131,579) deliveries. While the overall frequency of sepsis was stable (P = 0.95), the risk of severe sepsis and sepsis-related death increased during the study period, (P < 0.001) and (P = 0.02), respectively. Independent associations for severe sepsis, with an adjusted odds ratio and lower bound 95% CI higher than 3, include congestive heart failure, chronic liver disease, chronic renal disease, systemic lupus erythematous, and rescue cerclage placement.CONCLUSIONS: Maternal severe sepsis and sepsis-related deaths are increasing in the United States. Severe sepsis often occurs in the absence of a recognized risk factor and underscores the need for developing systems of care that increase sensitivity for disease detection across the entire population. Physicians should enhance surveillance in patients with congestive heart failure, chronic liver disease, chronic renal disease, and systemic lupus erythematous and institute early treatment when signs of sepsis are emerging.