Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: A matched, risk-adjusted, cohort study
Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: A matched, risk-adjusted, cohort study
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DOI：
10.1086/501639
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发表时间：
1999-06-01
影响因子：
4.5
通讯作者：
Chevret, S
中科院分区：
文献类型：
--
作者：
Soufir, L;Timsit, JF;Chevret, S
目的：在考虑重症监护病房（ICU）期间和CRS之前疾病严重程度的情况下，确定危重患者因导管相关性败血症（CRS）死亡的归因风险。设计：暴露-未暴露配对（1：2）研究。设置：10个床位的内科-外科ICU和18个床位的内科ICU。患者：1990年1月1日至1995年12月31日期间入住ICU的患者符合条件。暴露的患者被定义为CRS患者;未暴露的对照组根据匹配variables.METHODS：匹配变量为ICU入院时的诊断，感染前中心导管插入的长度，McCabe评分，入院时的简化急性生理评分（SAPS）II，年龄和性别。每例患者的严重程度评分（SAPS LI、器官系统衰竭评分、器官功能障碍和感染评分以及Logistic器官功能障碍系统）计算4次：ICU入院当天、CRS发作当天以及CRS前3天和7天。38例暴露患者的匹配成功。统计分析的基础上非参数检验的流行病学数据和考克斯的模型暴露-未暴露study.RESULTS的匹配变量和预后因素的死亡率进行调整：CRS复杂的1.17每100 ICU入院在研究期间。20例（53%）CRS病例与败血性休克相关。CRS与SAPS II增加28%相关。暴露和未暴露患者的ICU粗死亡率分别为50%和21%。即使在ICU入院时调整了其他预后因素，CRS仍与死亡率相关（相对风险[RR]，2.01; 95%置信区间[CI 95]，1.08-3.73; P=.03）。然而，在调整ICU入院和CRS前1周之间计算的严重程度评分后，死亡率的增加不再显著（RR 1.41; CI 95，0.76-2.61; P= 0.27）。结论：CRS与ICU随后的发病率和死亡率相关，即使在ICU入院时调整了严重程度因素。然而，在调整ICU期间和事件发生前的严重程度因素后，只有CRS归因的死亡率趋势。在评价ICU患者中医院事件诱导的过度死亡率时，应考虑患者严重程度的演变（Infect Control HospEpidemiol 1999;20：396-401）。
OBJECTIVE: To determine the attributable risk of death due to catheter-related septicemia (CRS) in critically ill patients when taking into account severity of illness during the intensive-care unit (ICU) stay but before CRS.DESIGN: Pairwise-matched (1:2) exposed-unexposed study.SETTING: 10-bed medical-surgical ICU and an 18-bed medical ICU.PATIENTS: Patients admitted to either ICU between January 1, 1990, and December 31, 1995, were eligible. Exposed patients were defined as patients with CRS; unexposed controls were selected according to matching variables.METHODS: Matching variables were diagnosis at ICU admission, length of central catheterization before the infection, McCabe Score, Simplified Acute Physiologic Score (SAPS) II at admission, age, and gender. Severity scores (SAPS LI, Organ System Failure Score, Organ Dysfunction and Infection Score, and Logistic Organ Dysfunction System) were calculated four times for each patient: the day of ICU admission, the day of CRS onset, and 3 and 7 days before CRS. Matching was successful for 38 exposed patients. Statistical analysis was based on nonparametric tests for epidemiological data and on Cox's models for the exposed-unexposed study, with adjustment on matching variables and prognostic factors of mortality.RESULTS: CRS complicated 1.17 per 100 ICU admissions during the study period. Twenty (53%) of the CRS cases were associated with septic shock. CRS was associated with a 28% increase in SAPS II. Crude ICU mortality rates from exposed and unexposed patients were 50% and 21%, respectively. CRS remained associated with mortality even when adjusted on other prognostic factors at ICU admission (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.08-3.73; P=.03). However, after adjustment on severity scores calculated between ICU admission and 1 week before CRS, the increased mortality was no longer significant (RR 1.41; CI95, 0.76-2.61; P=.27).CONCLUSION: CRS is associated with subsequent morbidity and mortality in the ICU, even when adjusted on severity factors at ICU admission. However, after adjustment on severity factors during the ICU stay and before the event, there was only a trend toward CRS-attributable mortality. The evolution of patient severity should be taken into account when evaluating excess mortality induced by nosocomial events in ICU patients (Infect Control Hosp Epidemiol 1999;20:396-401).