■脓毒症,具有显著的发病率和死亡率,与社会经济差异和入院前临床病史有着千丝万缕的联系。这项研究旨在阐明非COVID-19相关脓毒症与英格兰大流行期间健康不平等风险因素之间的关系,次要关注它们与30天脓毒症死亡率的关系。
■经英国NHS批准,我们利用OpenSAFELY平台进行了一项队列研究和一项1:6匹配的病例对照研究.使用ICD-10代码从事件医院入院记录中确定败血症诊断。这涵盖了从2019年1月1日至2022年6月31日的22O万人队列中的248,767例非COVID-19脓毒症病例。社会经济剥夺是使用多重剥夺指数来衡量的,反映收入等指标,employment,和教育。住院相关败血症诊断分为社区获得性或医院获得性。病例与没有记录的败血症诊断的对照组相匹配,根据年龄(逐步),性别,和日历月。建立对照的合格标准主要基于没有记录的脓毒症诊断。通过条件逻辑回归模型评估潜在预测因子与非COVID-19脓毒症发生几率之间的关联,使用多变量回归确定30天死亡率的比值比(ORs)。
■该研究包括224,361例(10.2%)非COVID-19脓毒症病例和1,346,166例匹配的对照。与最不剥夺的五分之一相比,最缺乏社会经济的五分之一患有非COVID-19败血症的几率更高(粗OR1.80[95%CI1.77-1.83])。其他风险因素(调整合并症后),如学习障碍(调整OR3.53[3.35-3.73]),慢性肝病(校正OR3.08[2.97-3.19]),慢性肾脏病(4期:校正OR2.62[2.55-2.70],阶段5:调整后OR6.23[5.81-6.69]),癌症,神经系统疾病,免疫抑制状态也与发生非COVID-19脓毒症相关.非COVID-19脓毒症的发病率在COVID-19大流行期间下降,在国家封锁解除后反弹至大流行前的水平(2021年4月)。非COVID-19脓毒症患者的30天死亡风险在所有时期都较高。
■社会经济剥夺,在英格兰,合并症和学习障碍与发生非COVID-19相关脓毒症和30日死亡率的几率增加相关.这项研究强调了提高预防脓毒症的必要性,包括更精确地将抗菌药物用于高危患者。
■英国卫生安全局,英国健康数据研究,和国家健康研究所。
UNASSIGNED: Sepsis, characterised by significant morbidity and mortality, is intricately linked to socioeconomic disparities and pre-admission clinical histories. This study aspires to elucidate the association between non-COVID-19 related sepsis and health inequality risk factors amidst the pandemic in England, with a secondary focus on their association with 30-day sepsis mortality.
UNASSIGNED: With the approval of NHS England, we harnessed the OpenSAFELY platform to execute a cohort study and a 1:6 matched
case-control study. A sepsis diagnosis was identified from the incident hospital admissions record using ICD-10 codes. This encompassed 248,767 cases with non-COVID-19 sepsis from a cohort of 22.0 million individuals spanning January 1, 2019, to June 31, 2022. Socioeconomic deprivation was gauged using the Index of Multiple Deprivation score, reflecting indicators like income, employment, and education. Hospitalisation-related sepsis diagnoses were categorised as community-acquired or hospital-acquired. Cases were matched to controls who had no recorded diagnosis of sepsis, based on age (stepwise), sex, and calendar month. The eligibility criteria for controls were established primarily on the absence of a recorded sepsis diagnosis. Associations between potential predictors and odds of developing non-COVID-19 sepsis underwent assessment through conditional logistic regression models, with multivariable regression determining odds ratios (ORs) for 30-day mortality.
UNASSIGNED: The study included 224,361 (10.2%) cases with non-COVID-19 sepsis and 1,346,166 matched controls. The most socioeconomic deprived quintile was associated with higher odds of developing non-COVID-19 sepsis than the least deprived quintile (crude OR 1.80 [95% CI 1.77-1.83]). Other risk factors (after adjusting comorbidities) such as learning disability (adjusted OR 3.53 [3.35-3.73]), chronic liver disease (adjusted OR 3.08 [2.97-3.19]), chronic kidney disease (stage 4: adjusted OR 2.62 [2.55-2.70], stage 5: adjusted OR 6.23 [5.81-6.69]), cancer, neurological disease, immunosuppressive conditions were also associated with developing non-COVID-19 sepsis. The incidence rate of non-COVID-19 sepsis decreased during the COVID-19 pandemic and rebounded to pre-pandemic levels (April 2021) after national lockdowns had been lifted. The 30-day mortality risk in cases with non-COVID-19 sepsis was higher for the most deprived quintile across all periods.
UNASSIGNED: Socioeconomic deprivation, comorbidity and learning disabilities were associated with an increased odds of developing non-COVID-19 related sepsis and 30-day mortality in England. This study highlights the need to improve the prevention of sepsis, including more precise targeting of antimicrobials to higher-risk patients.
UNASSIGNED: The UK Health Security Agency, Health Data Research UK, and National Institute for Health Research.