Late mortality after sepsis: propensity matched cohort study.
Late mortality after sepsis: propensity matched cohort study.
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DOI：
10.1136/bmj.i2375
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发表时间：
2016-05-17
期刊：
影响因子：
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通讯作者：
Iwashyna TJ
中科院分区：
文献类型：
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作者：
Prescott HC;Osterholzer JJ;Langa KM;Angus DC;Iwashyna TJ
目的确定脓毒症后的晚期死亡率主要是由先前存在的共病引起的还是脓毒症本身引起的。设计观察性队列研究。美国健康与退休研究。参与者960例年龄≥65岁（1998-2010年）的脓毒症住院患者，享受按服务付费的医疗保险。患者与777名目前未住院的成年人，788名非败血症感染患者和504名急性无菌炎症患者相匹配。主要结果测量晚期（31天至2年）死亡率和不同时间段的死亡几率。结果22.1%的患者合并脓毒症（95%置信区间17.5%至26.7%）晚期死亡率相对于未住院的成人绝对增加10.4%（5.4%至15.4%）相对于非脓毒症感染患者的绝对增加，相对于因无菌性炎症而入院的患者，绝对增加16.2%（10.2%至22.2%）（每次比较P<0.001）。与未住院的成年人相比，死亡率至少在两年内保持较高水平。结论：超过五分之一的脓毒症存活患者的晚期死亡不能用脓毒症前的健康状况解释。
Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself. Deign Observational cohort study. Setting US Health and Retirement Study. Participants 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions. Main outcome measures Late (31 days to two years) mortality and odds of death at various intervals. Results Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital. Conclusions More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.