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[JAMA在线发表]:全身性感染是美国非计划性再次入院的首要原因
2017年02月08日 时讯速递, 进展交流 暂无评论

Sepsis leading cause of early readmissions in the U.S.

By Will Boggs MD

January 27, 2017

NEW YORK (Reuters Health) – Unplanned 30-day readmissions are common after sepsis hospitalizations, according to data from the Nationwide Readmissions Database.

全国再次入院数据库的资料显示,患者因全身性感染住院后,30天内非计划再次入院非常普遍。

"The most interesting finding is that sepsis is the leading cause of 30-day readmissions in the U.S.,” Dr. Sachin Yende from VA Pittsburgh Healthcare System in Pennsylvania told Reuters Health by email. “Furthermore, readmissions following sepsis also cost more compared to readmissions following heart failure, heart attack, COPD, and pneumonia. Thus, sepsis accounts for a significant proportion of costs of readmissions.”

宾夕法尼亚州退伍军人匹兹堡医疗系统的Sachin Yende医生通过电子邮件对路透社健康频道说到:“最有趣的发现是,在美国,全身性感染是30天内再次入院的首要原因。而且,全身性感染后再次入院较心衰、心脏病、COPD及肺炎后再次入院的医疗费用更高。因此,全身性感染占再次入院医疗费用的相当比例。”

As part of its pay-for-performance program, the Centers for Medicare & Medicaid Services tracks readmissions following index hospitalizations for acute myocardial infarction (AMI), heart failure, COPD, and pneumonia, but not sepsis. The proportion and cost of unplanned readmissions following sepsis hospitalization were unknown until now.

作为按效付费模式的一部分,Medicare和Medicaid服务中心对因急性心梗(AMI)、心衰、COPD和肺炎而入院的患者再次入院进行监测,其中并不包括全身性感染。全身性感染入院后非计划再次入院的患者比例及医疗费用至今并不清楚。

To investigate, Dr. Yende and colleagues used data from the 2013 Nationwide Readmissions Database.

为此,Yende医生及其同事采用2013年全国再次入院数据库进行了研究。

Sepsis accounted for 12.2% of the more than 1.1 million unplanned 30-day readmissions, far more than readmissions after hospitalizations for AMI (1.3%), heart failure (6.7%), COPD (4.6%), or pneumonia (5.0%).

在全国30天内非计划再次入院的超过1100万例患者中,全身性感染占12.2%,远远超过因AMI (1.3%)、心衰(6.7%)、COPD (4.6%)或肺炎(5.0%)住院后再次入院的比例。

Sepsis patients commonly had additional diagnoses, including AMI (0.7%), heart failure (3.4%), COPD (3.3%), and pneumonia (7.5%), the researchers report in JAMA, online January 22.

1月22日,研究者在JAMA在线发表报告显示,全身性感染患者通常具有其他诊断,包括AMI (0.7%),心衰(3.4%),COPD (3.3%) 和肺炎(7.5%)。

Durations of unplanned readmissions were longer following sepsis hospitalization than readmissions following AMI, heart failure, COPD, and pneumonia, and the estimated mean cost per readmission was significantly higher for sepsis ($10,070) than for AMI ($9424), heart failure ($9051), COPD ($8417), or pneumonia ($9533).

与AMI、心衰、COPD和肺炎后再次入院相比,全身性感染住院后非计划再次入院时间更长,全身性感染再次入院的平均费用($10,070)也显著高于AMI ($9424)、心衰($9051)、COPD ($8417) 或肺炎 ($9533)。

“There are recent studies showing that since the hospital readmission reduction program (HRRP) started, readmissions for heart failure, COPD, pneumonia, and heart attack have decreased,” Dr. Yende said.

“近期研究显示,自从减少再次入院项目(HRRP)启动后,心衰、COPD、肺炎及心脏病再次入院明显减少。”Yende医生说到。

“Whether adding sepsis readmissions to HRRP improves patient outcomes is still unclear, but one could speculate that avoiding hospitalizations would reduce risk of hospital-acquired conditions (e.g., infections) and that most patients would prefer to avoid admission to the hospital,” he said.

“HRRP加入全身性感染能否改善患者预后尚不清楚,但人们可以推断,避免住院可以减少医院获得性疾病(如感染)的风险,多数患者会选择避免再次入院,”他谈到。

“Although sepsis is an acute condition, it has long-term sequelae that last long after hospital discharge,” he concluded. “Thus, providers should consider developing programs/interventions to reduce these sequelae.”

“尽管全身性感染是急性病,但其后遗症则为长期性,出院后很久仍然存在,”他总结到,“因此,医生应当考虑采取干预措施减少这些后遗症。”

Dr. Hallie Prescott from the University of Michigan Health System and VA Ann Arbor Healthcare System told Reuters Health by email, “We also know that a high proportion of these readmissions after sepsis are potentially preventable - suggesting that there may be an opportunity for improvement.”

密执根大学医疗中心及VA Ann Arbor医疗中心的Hallie Prescott医生在电子邮件中告诉路透社健康频道:“我们还知道,全身性感染后再次入院患者中大部分其实是可以预防的—提示可能存在很多继续改进的空间。”

“When treating sepsis survivors in clinic after hospitalization, we should focus our attention to common, treatable conditions that account for many of these readmissions - such as recurrent infection, heart failure exacerbation, renal failure, and aspiration,” said Dr. Prescott, an expert in pulmonary and critical care, who was not involved in the study.

“在诊所中对全身性感染住院存活患者进行诊治时,我们应当关注常见的可以治疗的情况,这导致了很多再次入院,如再发感染、心衰加重、肾功能衰竭及误吸,”作为呼吸及重症专家的Prescott医生谈到,他并未参加此项研究。

Dr. Faheem Guirgis, an emergency physician at the University of Florida's UF Health Jacksonville, said, “Sepsis is a big problem, and one of the most difficult and common conditions faced by healthcare providers and policy makers. Contributing to the challenge is the lack of gold-standard diagnostic tests for making the diagnosis, changing definitions, and the complexity of taking care of septic patients.”

Faheem Guirgis医生是佛罗里达大学Jacksonville健康中心的急诊科医生,他说到:“全身性感染是个大问题,也是医务人员及政策制定者所面临的最为困难的常见问题。造成这一挑战的原因包括诊断缺乏金标准,定义在不断改变,以及全身性感染患者诊治过程的复杂性。”

"Furthermore, as the population grows older, and as the chronic disease burden of the general population increases, patients become more susceptible to sepsis,” he told Reuters Health by email. “Elderly patients, patients on hemodialysis and chemotherapy, the more times they access a healthcare facility the higher their risk of infection, and thus the higher their risk of sepsis. It's almost a consequence of advanced care that allows people to live longer with more medical conditions."

“而且,随着人口老龄化,一般人群中慢性疾病负担不断增加,患者更容易发生全身性感染,”他在给路透社健康频道说到。“对于老年患者,接受血液透析及化疗的患者而言,他们到医院次数越多,感染的风险更高,因此,发生全身性感染的风险也相应增加。这几乎是医疗进步的通病,即使得有更多疾病的患者存活更久。”

"I think prevention is one key, but there are going to be many other pieces to this puzzle," said Dr. Guirgis, who also was not involved study.

“我认为预防是关键,但是还有很多其他因素”,Guirgis医生补充到,他也未参加此项研究。

"Sepsis should not be viewed as a one-and-done phenomenon," said Dr. Mark E. Mikkelsen, chief of medical critical care at Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

“不应将全身性感染视为一劳永逸的疾病,”身为费城宾夕法尼亚大学Perelman医学院内科ICU主任的Mark E. Mikkelsen医生谈到。

"As many as one in four sepsis survivors are readmitted within 30 days, many with a recurrent life-threatening infection," he told Reuters Health by email. "Arming patients with this knowledge is key, so that patients and clinicians can detect and treat new or recurrent infections in a timely manner after sepsis."

“多达1/4的全身性感染存活者在30天内再次入院,其中很多患者再发致命性感染,”他在电子邮件中对路透社健康频道提到。“向患者传授上述知识非常重要,在全身性感染后,患者及医生就能够及时发现并治疗新发或复发感染。”

"This study supports that the hospital readmission reduction program should add sepsis to their targeted conditions," said Dr. Mikkelsen, who was not part of the research.

“这项研究支持减少再次入院项目应当将全身性感染加入其监测疾病中,”Mikkelsen医生说到,他也未参加此项研究。

SOURCE: http://bit.ly/2kiwjtn

JAMA 2017.

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