脓毒血症干预治疗与住院期间患者死亡率的关系：真实数据回顾性分析
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Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data
背景与目的
脓毒症是对感染的全身反应，可导致组织损伤，器官衰竭和死亡。已经努力制定循证干预措施，以在疾病早期确定和控制脓毒症，以减少脓毒症相关的发病率和死亡率。我们用可靠的观察数据方法评估了微创脓毒症干预组与住院死亡率之间的关系。
方 法
我们对2012年1月1日至2014年12月31日期间在加州大学旧金山医学中心诊断为严重脓毒症/败血性休克（SS / SS）的成人出院患者进行了一项回顾性队列研究。脓毒症干预包括血乳酸测量;在开始使用抗生素前抽血培养;急诊科病人脓毒症发生3小时内使用广谱抗生素，住院病人1小时内使用;如果患者为低血压或乳酸盐水平> 4 mmol / L，则应用静脉补液；并且如果患者在输注液体后仍然低血压，则静脉应用血管加压剂。
结 果
整个干预依从性与死亡风险降低31％相关（调整后的发生率比率（IRR），0.69,95％置信区间[CI]，0.53-0.91），根据急诊科病人SS / SS表现、入院时已经出现SS / SS（ POA）、年龄、入院疾病严重程度和死亡风险、医疗补助/医疗保健支付者状态、免疫受损的宿主状态和充血性心力衰竭型POA来调整。调整后的需要治疗的人数（NNT）来挽救一个人的生命为15（CI，8-69）。与死亡率相关的其他独立因素包括入院时SS / SS （经调整的IRR，0.55; CI，0.32-0.92）和年龄增加（调整后的IRR，每10年增长1.13; CI，1.03-1.24）。
结 论
加利福尼亚大学旧金山分校的脓毒症病毒治疗与医院病房的住院死亡风险降低有关，因为混合因素和风险调整得到了强有力的控制。调整后的NNT提供了一个合理可行的目标，以评价诊断为SS / SS的患者预后改善的情况。
原始文献摘要
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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