中国西南地区某大型三甲综合医院脓毒症住院患者的流行病学分析

Epidemiological analysis of in patients with sepsis in a large tertiary general hospital in Southwest China

目的分析中国西南地区某大型三甲综合医院2年间脓毒症住院患者的流行病学特点,探讨脓毒症死亡相关危险因素。方法采用回顾性研究方法,选择2021年9月1日至2023年8月31日就诊于四川省人民医院并住院治疗的脓毒症患者。收集患者的性别、年龄、出院诊断、出院科室、住院费用、住院时间及住院期间的预后;比较住院期间不同预后两组患者的临床特征资料;采用多因素Logistic回归分析脓毒症患者发生住院死亡事件的危险因素。结果共纳入3568例脓毒症患者,中位年龄58(35,74)岁,男性2147例(占60.17%),中位住院时间13(8,24)d,中位住院费用3.98(1.87,8.83)万元。2年间脓毒症病例数超100例的住院科室分别为中心重症监护病房(ICU)、儿科、肾内科、急诊内科、急诊重症监护病房(EICU)、感染科、呼吸内科、血液内科、新生儿监护室和急诊外科,其中ICU(包括中心ICU和EICU)患者1210例(占33.91%)。ICU患者住院费用较高〔6.7(3.1,15.5)万元〕,住院时间较长〔9(3,17)d〕,病死率较高〔35.29%(427/1210)〕。3568例脓毒症患者中,住院期间死亡448例,存活3120例。死亡组脓毒症患者的年龄、男性比例和住院费用均明显高于生存组〔年龄(岁):75(60,86)比57(30,71),男性比例:67.86%(304/448)比59.07%(1843/3120),住院费用(万元):6.7(3.0,16.9)比3.7(1.8,8.1)〕,合并糖尿病比例明显低于生存组〔4.91%(22/448)比10.45%(326/3120)〕,住院时间明显短于生存组〔d:10.0(3.0,19.0)比13.0(8.0,24.0)〕,差异均有统计学意义(均P<0.01)。多因素Logistic回归分析显示,男性〔优势比(OR)=0.75,95%可信区间(95%CI)为0.59~0.96〕、高龄(OR=1.04,95%CI为1.03~1.05)及合并糖尿病(OR=0.32,95%CI为0.19~0.54)是脓毒症患者发生住院死亡事件的独立危险因素(均P<0.05)。结论中国西南地区脓毒症疾病负担较重,尤其是ICU患者病死率高、住院费用高,患者及社会的经济负担重。男性、高龄及合并糖尿病是脓毒症患者发生住院死亡事件的独立危险因素。

Objective To analyze the epidemiological characteristics of hospitalized patients diagnosed with sepsis in a large classⅢgeneral hospital in Southwest China in a period of 2 years,and to explore the risk factors related to death in patients with sepsis.Methods A retrospective study was conducted to select patients with sepsis admitted to Sichuan Provincial People's Hospital from September 1,2021 to August 31,2023,and general characteristics such as gender,age,discharge diagnosis,discharge department,hospitalization cost,length of stay,and prognosis during hospitalization were collected.The baseline of two groups of patients were compared,and the risk factors of in-hospital cause of death in patients with sepsis were analyzed by multivariate Logistic regression.Results A total of 3568 patients with sepsis were included with median age of 58(35,74)years old.Of all patients,there were 2147 males(60.17%).The median length of hospitalization was 13(8,24)days,and the median hospitalization cost was 3.98(1.87,8.83)ten thousand yuan.The departments with more than 100 cases of sepsis in 2 years were central intensive care unit(ICU),pediatrics department,nephrology department,emergency medicine department,emergency intensive care unit(EICU),infectious department,respiratory medicine department,hematology department,neonatal care unit and emergency surgical department.A total of 1210 patients(33.91%)admitted to ICU(including central ICU and EICU).The hospitalization cost of ICU patients were higher[6.7(3.1,15.5)ten thousand yuan],the hospitalization duration was longer[9(3,17)days],and the mortality was higher[35.29%(427/1210)].Among 3568 patients with sepsis,448 died and 3120 survived during hospitalization.The age,male proportion and hospitalization cost of patients with sepsis in the death group were significantly higher than those in the survival group[age(years old):75(60,86)vs.57(30,71),male proportion:67.86%(304/448)vs.59.07%(1843/3120),hospitalization cost(ten thousand yuan):6.7(3.0,16.9)vs.3.7(1.8,8.1)],the ratio of diabetes mellitus was significantly lower than that of survival group[4.91%(22/448)vs.10.45%(326/3120)],the length of hospitalization was shorter than that of survival group[days:10.0(3.0,19.0)vs.13.0(8.0,24.0)],the differences were statistically significant(all P<0.01).Multivariate Logistic regression analysis showed that male[odds ratio(OR)=0.75,95%confidence interval(95%CI)was 0.59-0.96],elder(OR=1.04,95%CI was 1.03-1.05)and diabetes(OR=0.32,95%CI was 0.19-0.54)were independent risk factors for in-hospital death in patients with sepsis(all P<0.05).Conclusions Sepsis is a heavy burden in Southwest China,especially for ICU,with high mortality,high hospitalization costs,and heavy economic burden on patients and society.Male,elder and diabetes were independent risk factors for in-hospital death of sepsis patients.