The Epidemiology of Sepsis in Chinese ICUs: A National Cross-Sectional Survey

Xie Jianfeng, Wang Hongliang, Kang Yan, et al 

Crit Care Med: December 5, 2019 doi: 10.1097/CCM.0000000000004155

Abstract

Objectives: 目的

We performed a national cross-sectional survey to determine the epidemiologic characteristics of patients with sepsis in ICU in China.

通过进行全国性横断面调查，以明确中国ICU内脓毒症的流行病学特征。

Design: 试验设计

A cross-section survey study.

横断面调查研究

Setting: 场景

Forty-four hospitals in mainland China from December 1, 2015, to January 31, 2016.

中国大陆地区44家医院，调查时间为2015年12月1日至2016年1月31日

Patients: 研究对象

All septic patients diagnosed according sepsis-1 criteria admitted to participating ICU.

研究期间入住ICU所有符合Sepsis-1.0诊断标准的新发脓毒症患者

Interventions: 干预措施

None.

无

Measurements and Main Results: 测定指标与主要结果

We recorded demographic, physiologic, and microbiological data with follow-up for 90 days or death, if sooner. The frequency of sepsis and 90-day mortality rate were computed, and the relationship with gross domestic product determined. Multivariate logistic regression analysis was used to determine risk factors for 90-day mortality in patients with sepsis. Two-thousand three-hundred twenty-two patients with sepsis were included in the analysis, of whom 786 patients (33.9%) had hospital-acquired sepsis. The most common infection site was the lung (68.2%), followed by abdomen (26.6%) and bloodstream (7.8%). The frequency of sepsis in the ICU was 20.6 cases per 100 ICU admissions (95% CI, 15.8–25.4) with a 90-day mortality of 35.5%. The proportion of sepsis, severe sepsis, and septic shock were 3.10%, 43.6%, and 53.3% with a 90-day mortality of 2.78%, 17.69%, and 51.94%, respectively. Older age, low body weight, higher Sequential Organ Failure Assessment score, the number of systemic inflammatory response syndrome criteria, comorbid with heart failure, hematologic cancer, immunosuppression, higher level of lactate, infection site (pneumonia and bloodstream) were associated with 90-day mortality.

记录患者随访90天内或至死亡（如果少于90天）的人口信息学、生理指标和微生物学数据。计算脓毒症的发病率和90天病死率，并确定其与国内生产总值(GDP)的关系。使用多因素logistic回归分析判断脓毒症患者90天病死率的危险因素。2,322例脓毒症患者纳入分析，其中医院获得性脓毒症786例(33.9%)。最常见的感染部位是肺部(68.2%)，其次是腹部(26.6%)和血液(7.8%)。ICU内脓毒症的发病率为20.6% (95% CI, 15.8-25.4)，90天病死率为35.5%。脓毒症、严重脓毒症和感染性休克的比例分别为3.10%、43.6%和53.3%，90天病死率分别为2.78%、17.69%和51.94%。高龄、低体重、SOFA评分较高、全身炎症反应综合征标准数、合并心力衰竭、血液肿瘤、免疫抑制、高乳酸水平、感染部位（肺炎和血液）与90天病死率相关。

Conclusions: 结论

Sepsis affects a fifth of patients admitted to ICUs in mainland China with a 90-day mortality rate of 35.5%. Our findings indicate that a large burden of sepsis, and we need to focus on sepsis as a quality improvement target in China given the high mortality. In addition, further studies are needed to delineate the epidemiology of sepsis outside the ICU.

脓毒症影响了中国大陆五分之一的ICU患者，90天病死率为35.5%。本研究结果提示，鉴于我国脓毒症的高发病率、高病死率及高医疗花费，未来需要进一步推进脓毒症的诊疗措施改进。此外，未来还需要进一步的研究来明确在ICU外的脓毒症流行病学情况。