The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study
The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study
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DOI：
10.1016/s1473-3099(17)30322-5
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发表时间：
2017-11-01
影响因子：
56.3
通讯作者：
Pontes Azevedo, Luciano Cesar
中科院分区：
文献类型：
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作者：
Machado, Flavia R.;Cavalcanti, Alexandre Biasi;Pontes Azevedo, Luciano Cesar
中等收入国家急性护理服务的败血症负担令人担忧。我们估计了巴西成人重症监护病房（ICU）脓毒症的发病率、患病率和死亡率，以及ICU组织因素与预后的关系。方法对ICU脓毒症患者进行为期1天的点流行病学研究，并对全国代表性的伪随机样本进行随访。我们制作了一个抽样框架，最初按地理区域分层。然后根据医院的主要收入来源（为普通公众服务vs私人保险个人）和ICU规模（10个或更少的床位vs 10个以上的床位）对每个阶层进行分层，最终产生40个阶层。我们在每一层随机抽取icu样本，以便在1690个巴西成人icu中登记所需的总床位。我们对患者进行随访，直到出院60天，根据患病率和住院时间估计发病率，并得出全国估计。我们使用随机效应logistic回归模型评估死亡率预后因素。结果2014年2月27日，在317个ICU中随机抽取227个（72%）ICU提供了2632例患者的数据，其中794例脓毒症（每100个ICU床位30.2例脓毒症患者，95% CI 28.4-31.9）。ICU脓毒症发生率为36.3 / 1000患者-天（95% CI 29.8-44.0）， 788例患者中有439例（55.7%）死亡（95% CI 52.2-59.2）。资源可得性低（优势比[OR] 1.67, 95% CI 1.02-2.75, p=0.045）和治疗的充足性（优势比[OR] 0.56, 0.37-0.84, p=0.006）与死亡率独立相关。预计每年重症监护病房治疗的成人败血症病例的发病率为每10万人中290例（95% CI 237.9-351.2），每年产生约42万例，其中23万例死于医院。在巴西，重症监护病房治疗的败血症的发病率、患病率和死亡率都很高。结果差别很大，并与能否获得足够的资源和治疗有关。我们的研究结果显示了脓毒症在资源有限的环境下的负担，强调了建立脓毒症预防、早期诊断和适当治疗方案的必要性。
Background The sepsis burden on acute care services in middle-income countries is a cause for concern. We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome.Methods We did a 1-day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample. We produced a sampling frame initially stratified by geographical region. Each stratum was then stratified by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata. In each stratum we selected a random sample of ICUs so as to enrol the total required beds in 1690 Brazilian adult ICUs. We followed up patients until hospital discharge censored at 60 days, estimated incidence from prevalence and length of stay, and generated national estimates. We assessed mortality prognostic factors using random-effects logistic regression models.Findings On Feb 27, 2014, 227 (72%) of 317 ICUs that were randomly selected provided data on 2632 patients, of whom 794 had sepsis (30.2 septic patients per 100 ICU beds, 95% CI 28.4-31.9). The ICU sepsis incidence was 36.3 per 1000 patient-days (95% CI 29.8-44.0) and mortality was observed in 439 (55.7%) of 788 patients (95% CI 52.2-59.2). Low availability of resources (odds ratio [OR] 1.67, 95% CI 1.02-2.75, p=0.045) and adequacy of treatment (OR 0.56, 0.37-0.84, p=0.006) were independently associated with mortality. The projected incidence rate is 290 per 100 000 population (95% CI 237.9-351.2) of adult cases of ICU-treated sepsis per year, which yields about 420 000 cases annually, of whom 230 000 die in hospital.Interpretation The incidence, prevalence, and mortality of ICU-treated sepsis is high in Brazil. Outcome varies considerably, and is associated with access to adequate resources and treatment. Our results show the burden of sepsis in resource-limited settings, highlighting the need to establish programmes aiming for sepsis prevention, early diagnosis, and adequate treatment.