Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2-Associated Sepsis.
Use of Electronic Clinical Data to Track Incidence and Mortality for SARS-CoV-2-Associated Sepsis.
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DOI：
10.1001/jamanetworkopen.2023.35728
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发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
Rhee, Chanu
中科院分区：
文献类型：
--
作者：
Shappell, Claire N.;Klompas, Michael;Chan, Christina;Chen, Tom;Kanjilal, Sanjat;Mckenna, Caroline;Rhee, Chanu
在新冠肺炎大流行期间，SARS-CoV-2相关脓毒症的频率和死亡率与推定的细菌性脓毒症有何不同？在这项对2020年3月至2022年11月期间马萨诸塞州5家医院431例SARS-CoV-017住院患者的回顾性队列研究中， -CoV-2相关性败血症出现在所有住院患者的1.5%和SARS-CoV-2阳性住院患者的28.2%，而推定的细菌性败血症出现在7.1%的住院患者中。在第一个和最后一个研究季度之间，与SARS-CoV-2相关的败血症死亡率从33.4%下降到14.9%，而推定的细菌性败血症死亡率稳定在14.5%。这些发现表明，与SARS-CoV-2相关的脓毒症是常见的，并且比新冠肺炎大流行早期推测的细菌性败血症有更高的死亡率。这项队列研究使用客观的电子临床标准，在马萨诸塞州的5家医院评估了SARS-CoV-2相关的败血症和假定的细菌性败血症的发生率和结果。由于不一致的定义和对病毒败血症认识不足，量化SARS-CoV-2相关脓毒症的负担的努力一直受到限制。使用客观的电子临床标准描述SARS-CoV-2相关性脓毒症与假定的细菌性脓毒症的发生率和结局。这项回顾性队列研究包括2020年3月至2022年11月期间在马萨诸塞州5家医院住院的成年人。SARS-CoV-2相关性脓毒症定义为SARS-CoV-2聚合酶链式反应阳性和并发器官功能障碍(即单纯鼻插管上方的氧气支持、血管升压剂、乳酸水平升高、肌酸或胆红素水平升高和/或血小板下降)。根据美国疾病控制和预防中心修订的成人败血症事件标准(即血液培养顺序、持续使用抗生素治疗以及器官功能障碍使用与SARS-CoV-2相关的脓毒症相同的阈值)来定义推定的细菌性败血症。使用负二项和Logistic回归模型评估SARS-CoV-2相关和推测的细菌性败血症的季度发病率(即住院比例)和住院死亡率的趋势。这项研究包括来自2 61个 5 95人的4 31个 017医院就诊(平均年龄57.9[19.8]岁，女性241个 131(55.9%)，来自学术医院的286个 397[66.5%])。在这些接触中，23SARS-CoV-2 76例(5.4%)来自 -CoV-2,6558(1.5%)例 -CoV-2相关性脓毒症，30例SARS-CoV-2感染者(7.1%)推定为细菌性败血症而不感染SARS-CoV-2。SARS-CoV-2相关脓毒症的住院粗死亡率从第一季度的1469例中的490例(33.4%)下降到上一季度的450例中的67例(14.9%)(调整后的优势比[AOR]，每季度0.88[95%CI，0.85-0.90])。推定为细菌性败血症的粗死亡率为4451/30604例 患者(14.5%)，且跨地区稳定(AOR，1.00[95%CI，0.99-1.01])。对200例SARS-CoV-2阳性住院患者的病历回顾证实，基于电子健康记录(EHR)的SARS-CoV-2相关脓毒症标准相对于脓毒症-3标准表现良好(90.6%[95%CI，80.7%-96.5%]敏感性；91.2%[95%CI，85.1%-95.4%]特异性)。在这项对住院成人进行的回顾性队列研究中，在新冠肺炎大流行的前33个月中，SARS-CoV-2约占败血症病例的六分之一。SARS-CoV-2相关脓毒症的住院死亡率很高，但随着时间的推移而下降，最终与推定的细菌性脓毒症相似。这些发现突显了SARS-CoV-2相关脓毒症的高负担，并证明了基于EHR的算法在进行病毒和细菌败血症监测方面的实用性。
How did the frequency and mortality for SARS-CoV-2–associated sepsis differ from presumed bacterial sepsis during the COVID-19 pandemic? In this retrospective cohort study of 431 017 inpatient encounters at 5 Massachusetts hospitals between March 2020 and November 2022, SARS-CoV-2–associated sepsis was present in 1.5% of all admissions and 28.2% of SARS-CoV-2–positive hospitalizations, whereas presumed bacterial sepsis was present in 7.1% of hospitalizations. Between the first and last study quarters, SARS-CoV-2–associated sepsis mortality decreased from 33.4% to 14.9% while presumed bacterial sepsis mortality was stable at 14.5%. These findings suggest that SARS-CoV-2–associated sepsis was common and had higher mortality than presumed bacterial sepsis early in the COVID-19 pandemic. This cohort study assesses the incidence and outcomes of SARS-CoV-2–associated sepsis vs presumed bacterial sepsis by using objective electronic clinical criteria at 5 Massachusetts hospitals. Efforts to quantify the burden of SARS-CoV-2–associated sepsis have been limited by inconsistent definitions and underrecognition of viral sepsis. To describe the incidence and outcomes of SARS-CoV-2–associated sepsis vs presumed bacterial sepsis using objective electronic clinical criteria. This retrospective cohort study included adults hospitalized at 5 Massachusetts hospitals between March 2020 and November 2022. SARS-CoV-2–associated sepsis was defined as a positive SARS-CoV-2 polymerase chain reaction test and concurrent organ dysfunction (ie, oxygen support above simple nasal cannula, vasopressors, elevated lactate level, rise in creatine or bilirubin level, and/or decline in platelets). Presumed bacterial sepsis was defined by modified US Centers for Disease Control and Prevention adult sepsis event criteria (ie, blood culture order, sustained treatment with antibiotics, and organ dysfunction using identical thresholds as for SARS-CoV-2–associated sepsis). Trends in the quarterly incidence (ie, proportion of hospitalizations) and in-hospital mortality for SARS-CoV-2–associated and presumed bacterial sepsis were assessed using negative binomial and logistic regression models. This study included 431 017 hospital encounters from 261 595 individuals (mean [SD] age 57.9 [19.8] years, 241 131 (55.9%) females, 286 397 [66.5%] from academic hospital site). Of these encounters, 23 276 (5.4%) were from SARS-CoV-2, 6558 (1.5%) had SARS-CoV-2–associated sepsis, and 30 604 patients (7.1%) had presumed bacterial sepsis without SARS-CoV-2 infection. Crude in-hospital mortality for SARS-CoV-2–associated sepsis declined from 490 of 1469 (33.4%) in the first quarter to 67 of 450 (14.9%) in the last (adjusted odds ratio [aOR], 0.88 [95% CI, 0.85-0.90] per quarter). Crude mortality for presumed bacterial sepsis was 4451 of 30 604 patients (14.5%) and stable across quarters (aOR, 1.00 [95% CI, 0.99-1.01]). Medical record reviews of 200 SARS-CoV-2–positive hospitalizations confirmed electronic health record (EHR)–based SARS-CoV-2–associated sepsis criteria performed well relative to sepsis-3 criteria (90.6% [95% CI, 80.7%-96.5%] sensitivity; 91.2% [95% CI, 85.1%-95.4%] specificity). In this retrospective cohort study of hospitalized adults, SARS-CoV-2 accounted for approximately 1 in 6 cases of sepsis during the first 33 months of the COVID-19 pandemic. In-hospital mortality rates for SARS-CoV-2–associated sepsis were high but declined over time and ultimately were similar to presumed bacterial sepsis. These findings highlight the high burden of SARS-CoV-2–associated sepsis and demonstrate the utility of EHR-based algorithms to conduct surveillance for viral and bacterial sepsis.
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影响因子：
9.6
作者：
Nolan, Margaret B.;Nolan, Matthew E.;Piasecki, Thomas M.;Fiore, Michael C.
通讯作者：
Fiore, Michael C.
DOI：
10.1016/j.cmi.2020.07.016
发表时间：
2020-12
期刊：
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
影响因子：
--
作者：
Langford BJ;So M;Raybardhan S;Leung V;Westwood D;MacFadden DR;Soucy JR;Daneman N
通讯作者：
Daneman N
影响因子：
33.9
作者：
Adjei, Stacey;Hong, Kai;Molinari, Noelle-Angelique M.;Bull-Otterson, Lara;Ajani, Umed A.;Gundlapalli, Adi, V;Harris, Aaron M.;Hsu, Joy;Kadri, Sameer S.;Starnes, Jon;Yeoman, Kristin;Boehmer, Tegan K.
通讯作者：
Boehmer, Tegan K.
影响因子：
24.3
作者：
Franco, Cosimo;Facciolongo, Nicola;Nava, Stefano
通讯作者：
Nava, Stefano
影响因子：
24
作者：
Lombardi, Carlo Mario;Carubelli, Valentina;Senni, Michele
通讯作者：
Senni, Michele