ICM:澳大利亚和新西兰重症成人中脓毒症和感染性休克的死亡率趋势

Abstract

Purpose

Sepsis is a major cause of mortality in intensive care unit (ICU) patients. Significant temporal improvements in survival were observed in Australia and New Zealand (ANZ) from 2000 to 2012. Whether this has continued remains uncertain, and current sepsis-related mortality in ANZ ICUs is unknown.

脓毒症是重症监护病房（ICU）患者死亡的主要原因。在2000年至2012年间，澳大利亚和新西兰（ANZ）观察到脓毒症患者生存率显著提高。但这一趋势是否持续至今仍不明确，当前ANZ地区ICU中与脓毒症相关的死亡率也尚不可知。

Methods

We studied adult ICU patients admitted with sepsis (based on the 3rd international consensus definition for sepsis and septic shock), between January 2000 and June 2023. Data were obtained from 219 ICUs that contributed to the ANZ Intensive Care Society Adult Patient Database. We used logistic regression models to study changes in in-hospital mortality over time.

我们研究了自2000年1月至2023年6月期间，因脓毒症（根据第3版国际脓毒症及感染性休克共识定义）入住ICU的成年患者。数据来自参与ANZ重症医学会成人患者数据库的219家ICU。我们使用逻辑回归模型分析住院死亡率随时间的变化趋势。

Results

Among 2,975,149 ICU admissions, 303,389 patients had sepsis. In-hospital mortality was 28% in 2000, falling to 13% in 2023 (adjusted OR 0.48; 95% confidence interval [CI] 0.43 to 0.54). Mortality decreased at a rate of 1.1% per year between 2000–2013, 0.3% per year between 2013–2020 (p < 0.001 for change in slope), and increased 0.9% per year between 2020–2023 (p < 0.001). A nadir of 11% was observed in 2020. Modelled linearly, in-hospital mortality decreased 4% per year from 2000 to 2020, independent of measurable confounding. Contemporary in-hospital mortality was 25% in those with septic shock, and 20% in those receiving invasive mechanical ventilation.

在2,975,149例ICU住院患者中，有303,389例诊断为脓毒症。住院死亡率从2000年的28%下降至2023年的13%（校正比值比[OR]为0.48；95%置信区间[CI]：0.43至0.54）。死亡率在2000–2013年间每年下降1.1%，2013–2020年间每年下降0.3%（斜率变化p < 0.001），而在2020–2023年间每年上升0.9%（p < 0.001）。2020年达到最低点，为11%。线性模型显示，在排除可测量的混杂因素后，2000年至2020年间住院死亡率每年下降4%。当前，感染性休克患者的住院死亡率为25%，接受有创机械通气治疗的患者为20%。

Conclusions

In-hospital mortality in adult ANZ ICU patients admitted with sepsis decreased significantly from 28% in 2000 to a nadir of 11% in 2020, independent of changes in case-mix. In-hospital mortality remains substantially higher with septic shock and in those receiving invasive mechanical ventilation.

自2000年至2020年，ANZ地区因脓毒症入住ICU的成年患者住院死亡率从28%显著下降至最低的11%，且这一下降独立于病例构成的变化。然而，感染性休克患者以及接受有创机械通气者的住院死亡率仍然明显更高。