Prevalence and Clinical Characteristics of Patients With Sepsis Discharge Diagnosis Codes and Short Lengths of Stay in U.S. Hospitals.
Prevalence and Clinical Characteristics of Patients With Sepsis Discharge Diagnosis Codes and Short Lengths of Stay in U.S. Hospitals.
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美国医院中脓毒症出院诊断代码和短期住院患者的患病率和临床特征。
DOI：
10.1097/cce.0000000000000373
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发表时间：
2021-03
影响因子：
--
通讯作者：
Rhee C
中科院分区：
文献类型：
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作者：
Kuye I;Anand V;Klompas M;Chan C;Kadri SS;Rhee C
一些被诊断为脓毒症的患者有非常短暂的住院治疗。了解这些患者的患病率和临床特征，可以深入了解脓毒症诊断是如何应用的，以及目前脓毒症定义所涵盖的疾病的广度。回顾性观察研究。Cerner HealthFacts数据集中的110家美国医院（主要队列）和马萨诸塞州东部的4家医院（用于详细病历审查的次要队列）。2016年4月至2017年12月住院的成人。没有。我们根据国际疾病分类第10版脓毒症代码（包括脓毒症、败血症、严重脓毒症和脓毒性休克）确定住院情况，并使用详细的电子健康记录数据比较“短期脓毒症”患者（定义为3天内存活出院）与非短期脓毒症患者。在Cerner队列中，67，733例患者有脓毒症出院诊断代码，包括6，918例（10.2%）短期住院。与非短期住院脓毒症患者相比，短期住院患者更年轻（中位年龄60岁vs 67岁），合并症较少（中位数Elixhauser评分为5 vs 13），血培养阳性率较低（8.2% vs 24.1%），ICU入院率较低（6.2% vs 31.6%），严重脓毒症/脓毒性休克代码频率较低（13.5% vs 36.6%）。几乎所有短期住院和非短期住院脓毒症患者在入院时均符合全身炎症反应综合征标准（分别为84.5%和87.5%）; 47.2%的短期住院患者入院时序贯器官衰竭评估评分为2或更高，而73.2%的长期住院患者。结果在二级四医院队列中相似。病历审查表明，医生通常根据全身炎症反应综合征标准、乳酸盐升高或血培养阳性而无并发器官功能障碍来诊断脓毒症。在这一大型美国队列中，每10例编码为脓毒症的患者中就有1例在3天内存活出院。虽然大多数短期住院患者符合全身炎症反应综合征标准，但他们符合脓毒症-3标准的时间不到一半。我们的研究结果强调了脓毒症-3定义的不完全吸收，传统和新脓毒症定义所涵盖的疾病严重程度的广度，以及一些脓毒症患者恢复非常迅速的可能性。
Some patients diagnosed with sepsis have very brief hospitalizations. Understanding the prevalence and clinical characteristics of these patients may provide insight into how sepsis diagnoses are being applied as well as the breadth of illnesses encompassed by current sepsis definitions. Retrospective observational study. One-hundred ten U.S. hospitals in the Cerner HealthFacts dataset (primary cohort) and four hospitals in Eastern Massachusetts (secondary cohort used for detailed medical record reviews). Adults hospitalized from April 2016 to December 2017. None. We identified hospitalizations with International Classification of Diseases, 10th Edition codes for sepsis (including sepsis, septicemia, severe sepsis, and septic shock) and compared “short stay sepsis” patients (defined as discharge alive within 3 d) versus nonshort stay sepsis patients using detailed electronic health record data. In the Cerner cohort, 67,733 patients had sepsis discharge diagnosis codes, including 6,918 (10.2%) with short stays. Compared with nonshort stay sepsis patients, short stay patients were younger (median age 60 vs 67 yr) and had fewer comorbidities (median Elixhauser score 5 vs 13), lower rates of positive blood cultures (8.2% vs 24.1%), lower rates of ICU admission (6.2% vs 31.6%), and less frequently had severe sepsis/septic shock codes (13.5% vs 36.6%). Almost all short stay and nonshort stay sepsis patients met systemic inflammatory response syndrome criteria at admission (84.5% and 87.5%, respectively); 47.2% of those with short stays had Sequential Organ Failure Assessment scores of 2 or greater at admission versus 73.2% of those with longer stays. Findings were similar in the secondary four-hospital cohort. Medical record reviews demonstrated that physicians commonly diagnosed sepsis based on the presence of systemic inflammatory response syndrome criteria, elevated lactates, or positive blood cultures without concurrent organ dysfunction. In this large U.S. cohort, one in 10 patients coded for sepsis were discharged alive within 3 days. Although most short stay patients met systemic inflammatory response syndrome criteria, they met Sepsis-3 criteria less than half the time. Our findings underscore the incomplete uptake of Sepsis-3 definitions, the breadth of illness severities encompassed by both traditional and new sepsis definitions, and the possibility that some patients with sepsis recover very rapidly.