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Abstract：
OBJECTIVE: The objective was to analyse the associations of intensive care unit (ICU) and high care unit (HCU) organisational structure on in-hospital mortality among patients with sepsis in Japan\'s acute care hospitals.
METHODS: Multicentre cross-sectional study.
METHODS: Patients with sepsis aged ≥18 years who received critical care in acute care hospitals throughout Japan between April 2018 and March 2019 were identified using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).
METHODS: None.
METHODS: 10 968 patients with sepsis were identified. ICUs were categorised into three groups: type 1 ICUs (fulfilling stringent staffing criteria such as experienced intensivists and high nurse-to-patient ratios), type 2 ICUs (less stringent criteria) and HCUs (least stringent criteria).
METHODS: The study\'s primary outcome measure was in-hospital mortality. Cox proportional hazards regression analysis was performed to examine the impact of ICU/HCU groups on in-hospital mortality.
RESULTS: We analysed 2411 patients (178 hospitals) in the type 1 ICU group, 3653 patients (422 hospitals) in the type 2 ICU group and 4904 patients (521 hospitals) in the HCU group. When compared with the type 1 ICU group, the adjusted HRs for in-hospital mortality were 1.12 (95% CI 1.04 to 1.21) for the type 2 ICU group and 1.17 (95% CI 1.08 to 1.26) for the HCU group.
CONCLUSIONS: ICUs that fulfil more stringent staffing criteria were associated with lower in-hospital mortality among patients with sepsis than HCUs. Differences in organisational structure may have an association with outcomes in patients with sepsis, and this was observed by the NDB.
METHODS: Multicentre cross-sectional study.
METHODS: Patients with sepsis aged ≥18 years who received critical care in acute care hospitals throughout Japan between April 2018 and March 2019 were identified using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).
METHODS: None.
METHODS: 10 968 patients with sepsis were identified. ICUs were categorised into three groups: type 1 ICUs (fulfilling stringent staffing criteria such as experienced intensivists and high nurse-to-patient ratios), type 2 ICUs (less stringent criteria) and HCUs (least stringent criteria).
METHODS: The study\'s primary outcome measure was in-hospital mortality. Cox proportional hazards regression analysis was performed to examine the impact of ICU/HCU groups on in-hospital mortality.
RESULTS: We analysed 2411 patients (178 hospitals) in the type 1 ICU group, 3653 patients (422 hospitals) in the type 2 ICU group and 4904 patients (521 hospitals) in the HCU group. When compared with the type 1 ICU group, the adjusted HRs for in-hospital mortality were 1.12 (95% CI 1.04 to 1.21) for the type 2 ICU group and 1.17 (95% CI 1.08 to 1.26) for the HCU group.
CONCLUSIONS: ICUs that fulfil more stringent staffing criteria were associated with lower in-hospital mortality among patients with sepsis than HCUs. Differences in organisational structure may have an association with outcomes in patients with sepsis, and this was observed by the NDB.
摘要：
目的：目的是分析重症监护病房（ICU）和高级监护病房（HCU）组织结构与日本急性护理医院败血症患者住院死亡率的关系。
方法：多中心横断面研究。
方法：使用日本国家健康保险索赔和特定健康检查数据库（NDB）确定了2018年4月至2019年3月在日本各地的急性护理医院接受重症监护的18岁以上脓毒症患者。
方法：无。
方法：确定10968例脓毒症患者。ICU分为三类：1型ICU（满足严格的人员配备标准，例如经验丰富的重症医师和高护士与患者的比率），2型ICU（不太严格的标准）和HCU（最不严格的标准）。
方法：本研究的主要结局指标是住院死亡率。进行Cox比例风险回归分析以检查ICU/HCU组对院内死亡率的影响。
结果：我们分析了1型ICU组的2411名患者（178家医院），2型ICU组3653例患者(422家医院)和HCU组4904例患者(521家医院)。与1型ICU组相比，2型ICU组和HCU组住院死亡率的校正HR分别为1.12(95%CI1.04~1.21)和1.17(95%CI1.08~1.26).
结论：符合更严格人员配置标准的ICU与脓毒症患者的住院死亡率低于HCU相关。组织结构的差异可能与脓毒症患者的预后有关，NDB观察到了这一点。
方法：多中心横断面研究。
方法：使用日本国家健康保险索赔和特定健康检查数据库（NDB）确定了2018年4月至2019年3月在日本各地的急性护理医院接受重症监护的18岁以上脓毒症患者。
方法：无。
方法：确定10968例脓毒症患者。ICU分为三类：1型ICU（满足严格的人员配备标准，例如经验丰富的重症医师和高护士与患者的比率），2型ICU（不太严格的标准）和HCU（最不严格的标准）。
方法：本研究的主要结局指标是住院死亡率。进行Cox比例风险回归分析以检查ICU/HCU组对院内死亡率的影响。
结果：我们分析了1型ICU组的2411名患者（178家医院），2型ICU组3653例患者(422家医院)和HCU组4904例患者(521家医院)。与1型ICU组相比，2型ICU组和HCU组住院死亡率的校正HR分别为1.12(95%CI1.04~1.21)和1.17(95%CI1.08~1.26).
结论：符合更严格人员配置标准的ICU与脓毒症患者的住院死亡率低于HCU相关。组织结构的差异可能与脓毒症患者的预后有关，NDB观察到了这一点。
