Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study

被引：106

作者：

Abe, Toshikazu ^{[1
,2
]}

Ogura, Hiroshi ^{[3
]}

Shiraishi, Atsushi ^{[4
]}

Kushimoto, Shigeki ^{[5
]}

Saitoh, Daizoh ^{[6
]}

Fujishima, Seitaro ^{[7
]}

Mayumi, Toshihiko ^{[8
]}

Shiino, Yasukazu ^{[9
]}

Nakada, Taka-aki ^{[10
]}

Tarui, Takehiko ^{[11
]}

Hifumi, Toru ^{[12
]}

Otomo, Yasuhiro ^{[13
]}

Okamoto, Kohji ^{[14
]}

Umemura, Yutaka ^{[3
]}

Kotani, Joji ^{[15
]}

Sakamoto, Yuichiro ^{[16
]}

Sasaki, Junichi ^{[17
]}

Shiraishi, Shin-ichiro ^{[18
]}

Takuma, Kiyotsugu ^{[19
]}

Tsuruta, Ryosuke ^{[20
]}

Hagiwara, Akiyoshi ^{[21
]}

Yamakawa, Kazuma ^{[22
]}

Masuno, Tomohiko ^{[23
]}

Takeyama, Naoshi ^{[24
]}

Yamashita, Norio ^{[25
]}

Ikeda, Hiroto ^{[26
]}

Ueyama, Masashi ^{[27
]}

Fujimi, Satoshi ^{[22
]}

Gando, Satoshi ^{[28
]}

机构：

[1] Juntendo Univ, Dept Gen Med, Bunkyo Ku, 2-1-1 Hongo, Tokyo 1130033, Japan

[2] Univ Tsukuba, Hlth Serv Res & Dev Ctr, Tsukuba, Ibaraki, Japan

[3] Osaka Univ, Grad Sch Med, Dept Traumatol & Acute Crit Med, Osaka, Japan

[4] Kameda Med Ctr, Emergency & Trauma Ctr, Kamogawa, Japan

[5] Tohoku Univ, Grad Sch Med, Div Emergency & Crit Care Med, Sendai, Miyagi, Japan

[6] Natl Def Med Coll, Res Inst, Div Traumatol, Tokorozawa, Saitama, Japan

[7] Keio Univ, Sch Med, Ctr Gen Med Educ, Tokyo, Japan

[8] Univ Occupat & Environm Hlth, Sch Med, Dept Emergency Med, Kitakyushu, Fukuoka, Japan

[9] Kawasaki Med Sch, Dept Acute Med, Kurashiki, Okayama, Japan

[10] Chiba Univ, Grad Sch Med, Dept Emergency & Crit Care Med, Chiba, Japan

[11] Kyorin Univ, Sch Med, Dept Trauma & Crit Care Med, Tokyo, Japan

[12] St Lukes Int Hosp, Dept Emergency & Crit Care Med, Tokyo, Japan

[13] Tokyo Med & Dent Univ, Hosp Med, Trauma & Acute Crit Care Ctr, Tokyo, Japan

[14] Kitakyushu City Yahata Hosp, Ctr Gastroenterol & Liver Dis, Dept Surg, Kitakyushu, Fukuoka, Japan

[15] Kobe Univ, Grad Sch Med, Dept Disaster & Emergency Med, Kobe, Hyogo, Japan

[16] Saga Univ Hosp, Emergency & Crit Care Med, Saga, Japan

[17] Keio Univ, Sch Med, Dept Emergency & Crit Care Med, Tokyo, Japan

[18] Aizu Chuo Hosp, Dept Emergency & Crit Care Med, Aizu Wakamatsu, Fukushima, Japan

[19] Kawasaki Municipal Kawasaki Hosp, Emergency & Crit Care Ctr, Kawasaki, Kanagawa, Japan

[20] Yamaguchi Univ, Adv Med Emergency & Crit Care Ctr, Ube, Yamaguchi, Japan

[21] Natl Ctr Global Hlth & Med, Ctr Hosp, Tokyo, Japan

[22] Osaka Gen Med Ctr, Div Trauma & Surg Crit Care, Osaka, Japan

[23] Nippon Med Sch, Dept Emergency & Crit Care Med, Tokyo, Japan

[24] Aichi Med Univ Hosp, Adv Crit Care Ctr, Nagakute, Aichi, Japan

[25] Kurume Univ Hosp, Adv Emergency Med Serv Ctr, Kurume, Fukuoka, Japan

[26] Teikyo Univ, Sch Med, Dept Emergency Med, Tokyo, Japan

[27] Japan Community Healthcare Org, Chukyo Hosp, Dept Trauma Crit Care Med & Burn Ctr, Nagoya, Aichi, Japan

[28] Hokkaido Univ, Grad Sch Med, Div Acute & Crit Care Med, Sapporo, Hokkaido, Japan

来源：

CRITICAL CARE | 2018年 / 22卷

关键词：

Sepsis; Bundle; Resuscitation; Elderly; INTERNATIONAL CONSENSUS DEFINITIONS; GOAL-DIRECTED RESUSCITATION; SEPTIC SHOCK; CLINICAL-CRITERIA; CAMPAIGN; MULTICENTER; INFECTION; EPIDEMIOLOGY; POPULATION; GUIDELINES;

D O I：

10.1186/s13054-018-2186-7

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BackgroundSepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management, and outcomes of patients with severe sepsis in Japan.MethodsThis is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) study, which was a multicenter, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria.ResultsIn total, 1184 patients (median age 73years, interquartile range (IQR) 64-81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus (23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6-11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multilevel logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21-26%). Older age, multiple comorbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12-46) days. Approximately 37% of the patients were discharged home after recovery.ConclusionOur prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple comorbidities in the ICUs in Japan.Trial registrationUMIN-CTR, UMIN000019742. Registered on 16 November 2015.

引用

页数：12

共 43 条

[1] A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators [J].

Angus, D. C. ;

Barnato, A. E. ;

Bell, D. ;

Bellomo, R. ;

Chong, C. -R. ;

Coats, T. J. ;

Davies, A. ;

Delaney, A. ;

Harrison, D. A. ;

Holdgate, A. ;

Howe, B. ;

Huang, D. T. ;

Iwashyna, T. ;

Kellum, J. A. ;

Peake, S. L. ;

Pike, F. ;

Reade, M. C. ;

Rowan, K. M. ;

Singer, M. ;

Webb, S. A. R. ;

Weissfeld, L. A. ;

Yealy, D. M. ;

Young, J. D. .

INTENSIVE CARE MEDICINE, 2015, 41 (09) :1549-1560

[2]

[Anonymous], CRIT CARE MED

[3]

[Anonymous], 2014, NEW ENGL J MED, DOI DOI 10.1056/NEJMoa1401602

[4] Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients: A comparison between middle-aged, old, and very old patients [J].

Blot, Stijn ;

Cankurtaran, Mustafa ;

Petrovic, Mirko ;

Vandijck, Dominique ;

Lizy, Christelle ;

Decruyenaere, Johan ;

Danneels, Christian ;

Vandewoude, Koenraad ;

Piette, Anne ;

Vershraegen, Gerda ;

Van Den Noortgate, Nele ;

Peleman, Renaat ;

Vogelaers, Dirk .

CRITICAL CARE MEDICINE, 2009, 37 (05) :1634-1641

[5] Why don't physicians follow clinical practice guidelines? A framewouk for improvement [J].

Cabana, MD ;

Rand, CS ;

Powe, NR ;

Wu, AW ;

Wilson, MH ;

Abboud, PAC ;

Rubin, HR .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 282 (15) :1458-1465

[6] Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine [J].

Cecconi, Maurizio ;

De Backer, Daniel ;

Antonelli, Massimo ;

Beale, Richard ;

Bakker, Jan ;

Hofer, Christoph ;

Jaeschke, Roman ;

Mebazaa, Alexandre ;

Pinsky, Michael R. ;

Teboul, Jean Louis ;

Vincent, Jean Louis ;

Rhodes, Andrew .

INTENSIVE CARE MEDICINE, 2014, 40 (12) :1795-1815

[7] Effect of Performance Improvement Programs on Compliance with Sepsis Bundles and Mortality: A Systematic Review and Meta-Analysis of Observational Studies [J].

Damiani, Elisa ;

Donati, Abele ;

Serafini, Giulia ;

Rinaldi, Laura ;

Adrario, Erica ;

Pelaia, Paolo ;

Busani, Stefano ;

Girardis, Massimo .

PLOS ONE, 2015, 10 (05)

[8]

DELLINGER RP, 2013, INTENS CARE MED, V39, P165, DOI DOI 10.1007/s00134-012-2769-8

[9] Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness [J].

Eskesen, T. G. ;

Wetterslev, M. ;

Perner, A. .

INTENSIVE CARE MEDICINE, 2016, 42 (03) :324-332

[10] Assessment of Global Incidence and Mortality of Hospital-treated Sepsis [J].

Fleischmann, Carolin ;

Scherag, Andre ;

Adhikari, Neill K. J. ;

Hartog, Christiane S. ;

Tsaganos, Thomas ;

Schlattmann, Peter ;

Angus, Derek C. ;

Reinhart, Konrad .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2016, 193 (03) :259-272

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