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膿毒血癥干預(yù)治療與住院期間患者死亡率的關(guān)系:真實數(shù)據(jù)回顧性分析

 罌粟花anesthGH 2021-07-21

    本公眾號每天分享一篇最新一期Anesthesia & Analgesia等SCI雜志的摘要翻譯,,敬請關(guān)注并提出寶貴意見     

Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data

背景與目的

膿毒癥是對感染的全身反應(yīng),,可導(dǎo)致組織損傷,器官衰竭和死亡,。已經(jīng)努力制定循證干預(yù)措施,,以在疾病早期確定和控制膿毒癥,,以減少膿毒癥相關(guān)的發(fā)病率和死亡率。我們用可靠的觀察數(shù)據(jù)方法評估了微創(chuàng)膿毒癥干預(yù)組與住院死亡率之間的關(guān)系,。

方  法

我們對2012年1月1日至2014年12月31日期間在加州大學(xué)舊金山醫(yī)學(xué)中心診斷為嚴(yán)重膿毒癥/敗血性休克(SS / SS)的成人出院患者進行了一項回顧性隊列研究,。膿毒癥干預(yù)包括血乳酸測量;在開始使用抗生素前抽血培養(yǎng);急診科病人膿毒癥發(fā)生3小時內(nèi)使用廣譜抗生素,住院病人1小時內(nèi)使用;如果患者為低血壓或乳酸鹽水平> 4 mmol / L,,則應(yīng)用靜脈補液,;并且如果患者在輸注液體后仍然低血壓,則靜脈應(yīng)用血管加壓劑,。

結(jié)  果

 整個干預(yù)依從性與死亡風(fēng)險降低31%相關(guān)(調(diào)整后的發(fā)生率比率(IRR),,0.69,95%置信區(qū)間[CI],0.53-0.91),,根據(jù)急診科病人SS / SS表現(xiàn),、入院時已經(jīng)出現(xiàn)SS / SS( POA)、年齡,、入院疾病嚴(yán)重程度和死亡風(fēng)險,、醫(yī)療補助/醫(yī)療保健支付者狀態(tài)、免疫受損的宿主狀態(tài)和充血性心力衰竭型POA來調(diào)整,。調(diào)整后的需要治療的人數(shù)(NNT)來挽救一個人的生命為15(CI,8-69),。與死亡率相關(guān)的其他獨立因素包括入院時SS / SS (經(jīng)調(diào)整的IRR,,0.55; CI,0.32-0.92)和年齡增加(調(diào)整后的IRR,,每10年增長1.13; CI,,1.03-1.24)。

結(jié)  論

加利福尼亞大學(xué)舊金山分校的膿毒癥病毒治療與醫(yī)院病房的住院死亡風(fēng)險降低有關(guān),,因為混合因素和風(fēng)險調(diào)整得到了強有力的控制,。調(diào)整后的NNT提供了一個合理可行的目標(biāo),以評價診斷為SS / SS的患者預(yù)后改善的情況,。

原始文獻摘要

Prasad PA,Shea ER; Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data ; Anesth Analg. Aug 2017;125(2):507-513.

BACKGROUND: Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data.

METHODS:We performed a retrospective cohort study at the University of California, San Francisco, Medical Center among adult patients discharged between January 1, 2012, and December 31, 2014, and who received a diagnosis of severe sepsis/septic shock (SS/SS). Sepsis intervention bundle elements included measurement of blood lactate; drawing of blood cultures before starting antibiotics; initiation of broad spectrum antibiotics within 3 hours of sepsis presentation in the emergency department or 1 hour of presentation on an inpatient unit; administration of intravenous fluid bolus if the patient was hypotensive or had a lactate level >4 mmol/L; and starting intravenous vasopressors if the patient remained hypotensive after fluid bolus administration. Poisson regression for a binary outcome variable was used to estimate an adjusted incidence-rate ratio (IRR) comparing mortality in groups defined by bundle compliance measured as a binary predictor, and to estimate an adjusted number needed to treat (NNT).

RESULTS:Complete bundle compliance was associated with a 31% lower risk of mortality (adjusted IRR, 0.69, 95% confidence interval [CI], 0.53-0.91), adjusting for SS/SS presentation in the emergency department, SS/SS present on admission (POA), age, admission severity of illness and risk of mortality, Medicaid/Medicare payor status, immunocompromised host status, and congestive heart failure POA. The adjusted NNT to save one life was 15 (CI, 8-69). Other factors independently associated with mortality included SS/SS POA (adjusted IRR, 0.55; CI, 0.32-0.92) and increased age (adjusted IRR, 1.13 per 10-year increase in age; CI, 1.03-1.24).

CONCLUSIONS:The University of California, San Francisco, sepsis bundle was associated with a decreased risk of in-hospital mortality across hospital units after robust control for confounders and risk adjustment. The adjusted NNT provides a reasonable and achievable goal to observe measureable improvements in outcomes for patients diagnosed with SS/SS.

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