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Abstract：
BACKGROUND: Although mortality due to sepsis has decreased in recent decades, there are few studies on the timing of death during ICU stay. Characteristics of patients related to changes over the years of ICU death and changes in the timing of ICU death will provide new insights for future sepsis management.
METHODS: This was a single-center, retrospective study. Patients admitted to the ICU for sepsis between 2005 and 2019 were included in the study. The study period was divided into three five-year intervals, and the timing of death in the ICU was divided into early-stage (1-3 ICU days), mid-stage (4-14 ICU days), and late-stage (15 or more ICU days). Patient characteristics related to ICU death at three five-year intervals and the timing of death were evaluated.
RESULTS: ICU mortality for sepsis has decreased over time (2005-2009, 30.2%; 2010-2014, 21.0%; 2015-2019, 12.1%; p<0.01). In the timing of death, only mid-stage mortality decreased. Multiple-organ failure (OR, 4.53; 95% CI, 2.79-7.48) and hematological malignancies (OR, 2.48; 95% CI, 1.19-5.07) were associated with ICU mortality over entire study periods. Only multiple-organ failure was associated with ICU mortality at the five-year intervals (OR, 5.94; 95% CI, 2.73-13.7 for 2005-2009; OR, 4.01; 95% CI, 1.82-9.31 for 2010-2014; OR, 2.58; 95% CI, 1.05-6.59 for 2015-2019). Mid-stage mortality of multiple-organ failure decreased (2005-2009, 12.8%; 2010-2014, 7.6%; 2015-2019, 1.6%; p=0.02). However, early- and late-stage mortality of multiple-organ failure did not change.
CONCLUSIONS: Improvement in mid-stage mortality in septic patients with multiple-organ failure can contribute to the improvement of overall ICU mortality in patients with sepsis.
METHODS: This was a single-center, retrospective study. Patients admitted to the ICU for sepsis between 2005 and 2019 were included in the study. The study period was divided into three five-year intervals, and the timing of death in the ICU was divided into early-stage (1-3 ICU days), mid-stage (4-14 ICU days), and late-stage (15 or more ICU days). Patient characteristics related to ICU death at three five-year intervals and the timing of death were evaluated.
RESULTS: ICU mortality for sepsis has decreased over time (2005-2009, 30.2%; 2010-2014, 21.0%; 2015-2019, 12.1%; p<0.01). In the timing of death, only mid-stage mortality decreased. Multiple-organ failure (OR, 4.53; 95% CI, 2.79-7.48) and hematological malignancies (OR, 2.48; 95% CI, 1.19-5.07) were associated with ICU mortality over entire study periods. Only multiple-organ failure was associated with ICU mortality at the five-year intervals (OR, 5.94; 95% CI, 2.73-13.7 for 2005-2009; OR, 4.01; 95% CI, 1.82-9.31 for 2010-2014; OR, 2.58; 95% CI, 1.05-6.59 for 2015-2019). Mid-stage mortality of multiple-organ failure decreased (2005-2009, 12.8%; 2010-2014, 7.6%; 2015-2019, 1.6%; p=0.02). However, early- and late-stage mortality of multiple-organ failure did not change.
CONCLUSIONS: Improvement in mid-stage mortality in septic patients with multiple-organ failure can contribute to the improvement of overall ICU mortality in patients with sepsis.
摘要：
背景：尽管近几十年来脓毒症导致的死亡率有所下降，关于ICU住院期间死亡时间的研究很少。与ICU死亡多年变化相关的患者特征和ICU死亡时间的变化将为未来的脓毒症管理提供新的见解。
方法：这是一个单中心，回顾性研究。2005年至2019年期间因脓毒症入院ICU的患者被纳入研究。研究期间分为三个五年间隔，ICU死亡时间分为早期（ICU1-3天），中期（4-14天ICU），和晚期（ICU15天或更长时间）。评估了与ICU死亡相关的三个五年间隔的患者特征和死亡时间。
结果：ICU脓毒症死亡率随着时间的推移有所下降（2005-2009年，30.2%；2010-2014年，21.0%；2015-2019年，12.1%；p<0.01）。在死亡的时机，只有中期死亡率下降。多器官衰竭（OR，4.53；95%CI，2.79-7.48）和血液恶性肿瘤（OR，2.48；95%CI，1.19-5.07）与整个研究期间的ICU死亡率相关。仅多器官功能衰竭与5年间隔的ICU死亡率相关(OR，5.94；2005-2009年95%CI，2.73-13.7；OR，4.01；95%CI，2010-2014年1.82-9.31；或，2.58；2015-2019年95%CI，1.05-6.59）。多器官功能衰竭的中期死亡率下降（2005-2009年，12.8%；2010-2014年，7.6%；2015-2019年，1.6%；p=0.02）。然而,多器官功能衰竭的早期和晚期死亡率没有变化。
结论：脓毒症合并多器官功能衰竭患者中期死亡率的改善有助于脓毒症患者ICU整体死亡率的改善。
方法：这是一个单中心，回顾性研究。2005年至2019年期间因脓毒症入院ICU的患者被纳入研究。研究期间分为三个五年间隔，ICU死亡时间分为早期（ICU1-3天），中期（4-14天ICU），和晚期（ICU15天或更长时间）。评估了与ICU死亡相关的三个五年间隔的患者特征和死亡时间。
结果：ICU脓毒症死亡率随着时间的推移有所下降（2005-2009年，30.2%；2010-2014年，21.0%；2015-2019年，12.1%；p<0.01）。在死亡的时机，只有中期死亡率下降。多器官衰竭（OR，4.53；95%CI，2.79-7.48）和血液恶性肿瘤（OR，2.48；95%CI，1.19-5.07）与整个研究期间的ICU死亡率相关。仅多器官功能衰竭与5年间隔的ICU死亡率相关(OR，5.94；2005-2009年95%CI，2.73-13.7；OR，4.01；95%CI，2010-2014年1.82-9.31；或，2.58；2015-2019年95%CI，1.05-6.59）。多器官功能衰竭的中期死亡率下降（2005-2009年，12.8%；2010-2014年，7.6%；2015-2019年，1.6%；p=0.02）。然而,多器官功能衰竭的早期和晚期死亡率没有变化。
结论：脓毒症合并多器官功能衰竭患者中期死亡率的改善有助于脓毒症患者ICU整体死亡率的改善。
