Population burden of long-term survivorship after severe sepsis in older Americans.
Population burden of long-term survivorship after severe sepsis in older Americans.
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DOI：
10.1111/j.1532-5415.2012.03989.x
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发表时间：
2012-06
影响因子：
6.3
通讯作者：
Kahn JM
中科院分区：
文献类型：
--
作者：
Iwashyna TJ;Cooke CR;Wunsch H;Kahn JM
严重脓毒症与老年幸存者的持续高发病率相关。但严重脓毒症对人群健康的影响，尤其是对人群残疾水平的影响，尚不清楚。确定严重败血症患者在医疗保险中存活至少3年的绝对数量，并估计他们的认知功能障碍和残疾负担。医疗保险数据的回顾性队列分析。1996-2008年美国所有短期住院医院。65岁及以上患者。使用标准行政定义检测严重脓毒症。计算病死率、患病率和发病率。在2008年底，有637,867名在严重败血症3年或更早前存活的医疗保险患者。估计有476,862人（95% CI: 455,026, 498,698）患有功能性残疾，106,311人（95% CI: 79,692, 133,930）患有中度至重度认知障碍。1998-2008年间，严重脓毒症3年生存率上升了119%。生存率的增加是由于更多新诊断的严重败血症，而不是病死率的变化；严重脓毒症的发生率从13.0 / 1000医疗保险受益人年上升到25.8 / 1000 (p<0.001)，而在同一队列中，3年病死率变化较小，从73.5%上升到71.3% （p<0.001）。住院患者器官功能障碍率的增加导致严重败血症发生率的增加，人口老龄化也有额外的小贡献。脓毒症的存活，伴随着大量的长期发病率，是美国老年人普遍且迅速增长的公共卫生问题。尽管实践发生了变化，但长期病死率几乎没有变化。临床医生应该预期更频繁的严重败血症的后遗症，在他们的病人群体。
Severe sepsis is associated with persistent high-levels of morbidity among older survivors. But the impact of severe sepsis on population health—particularly population levels of disability—is unknown. Ascertain the absolute number of patients surviving at least 3 years after severe sepsis in Medicare, and estimate their burden of cognitive dysfunction and disability. Retrospective cohort analysis of Medicare data. All short-stay inpatient hospitals in the United States, 1996–2008. Patients aged 65 and older. Severe sepsis was detected using a standard administrative definition. Case-fatality, prevalence and incidence rates were calculated. There were 637,867 Medicare patients alive at the end of 2008 who survived severe sepsis 3 or more years earlier. An estimated 476,862 (95% CI: 455,026, 498,698) had functional disability, with 106,311 (95% CI: 79,692, 133,930) survivors having moderate-to-severe cognitive impairment. The annual number of new 3-year survivors following severe sepsis rose 119% during 1998–2008. The increase in survivorship resulted from more new diagnoses of severe sepsis rather than a change in case fatality rates; severe sepsis rates rose from 13.0 per 1,000 Medicare beneficiary-years to 25.8 (p<0.001), whereas 3-year case fatality rates changed much less, from 73.5%to 71.3% (p<0.001) for the same cohort. Increasing rates of organ dysfunction among hospitalized patients drove the increase in severe sepsis incidence, with an additional small contribution from population aging. Sepsis survivorship, which carries with it substantial long-term morbidity, is a common and rapidly growing public health problem for older Americans. There has been little change in long-term case fatality, despite changes in practice. Clinicians should anticipate more frequent sequelae of severe sepsis in their patient populations.
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影响因子：
8.8
作者：
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通讯作者：
de la Torre-Prados, Maria Victoria
影响因子：
8.8
作者：
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通讯作者：
Ramsay, G