Introduction
Materials and methods
Database
Patient selection and study protocol
Statistical analysis
Results
Characteristics | Total (N = 373,539) | 2011 (N = 49,116) | 2012 (N = 54,622) | 2013 (N = 58,092) | 2014 (N = 60,608) | 2015 (N = 66,511) | 2016 (N = 84,590) | P |
---|---|---|---|---|---|---|---|---|
Sex, n (%) | 373,539 (100) | 49,116(100) | 54,622 (100) | 58,092 (100) | 60,608 (100) | 66,511 (100) | 84,590 (100) | |
Male | 186,833 (50.0) | 25,362 (51.6) | 28,128 (51.5) | 29,414 (50.6) | 30,220 (49.9) | 32,502 (48.9) | 41,207 (48.7) | <.0001 |
Female | 186,706 (50.0) | 23,754 (48.4) | 26,494 (48.5) | 28,678 (49.4) | 30,388 (50.1) | 34,009 (51.1) | 43,383 (51.3) | |
Age (years), Mean (SD) | 68.94 (15.32) | 67.25 (15.35) | 68.18 (15.3) | 68.74 (15.2) | 69.28 (15.09) | 69.62 (15.26) | 69.76 (15.38) | <.0001 |
18 ≤ age < 30 | 8184 (2.2) | 1265 (2.6) | 1241 (2.3) | 1198 (2.1) | 1199 (2.0) | 1419 (2.1) | 1862 (2.2) | <.0001 |
30 ≤ age < 40 | 11,380 (3.0) | 1824 (3.7) | 1748 (3.2) | 1752 (3.0) | 1740 (2.9) | 1867 (2.8) | 2449 (2.9) | |
40 ≤ age < 50 | 23,446 (6.3) | 3518 (7.2) | 3733 (6.8) | 3809 (6.6) | 3616 (6.0) | 3857 (5.8) | 4913 (5.8) | |
50 ≤ age < 60 | 48,803 (13.1) | 6968 (14.2) | 7377 (13.5) | 7741 (13.3) | 8017 (13.2) | 8358 (12.6) | 10,342 (12.2) | |
60 ≤ age < 70 | 66,930 (17.9) | 9579 (19.5) | 9932 (18.2) | 10,186 (17.5) | 10,497 (17.3) | 11,664 (17.5) | 15,072 (17.8) | |
70 ≤ age < 80 | 115,087 (30.8) | 15,112 (30.8) | 17,345 (31.8) | 18,592 (32.0) | 19,192 (31.7) | 20,188 (30.4) | 24,658 (29.2) | |
80 ≤ age | 99,709 (26.7) | 10,850 (22.1) | 13,246 (24.3) | 14,814 (25.5) | 16,347 (27.0) | 19,158 (28.8) | 25,294 (29.9) | |
Comorbidities, n (%) | ||||||||
Hypertension | 174,364 (46.7) | 22,644 (46.1) | 25,817 (47.3) | 27,932 (48.1) | 29,272 (48.3) | 31,697 (47.7) | 37,002 (43.7) | <.0001 |
Diabetes | 88,157 (23.6) | 11,548 (23.5) | 13,232 (24.2) | 14,352 (24.7) | 15,101 (24.9) | 16,122 (24.2) | 17,802 (21.0) | <.0001 |
Liver cirrhosis | 27,662 (7.4) | 3963 (8.1) | 4246 (7.8) | 4401 (7.6) | 4612 (7.6) | 4751 (7.1) | 5689 (6.7) | <.0001 |
Chronic kidney disease | 51,157 (13.7) | 6453 (13.1) | 7271 (13.3) | 8087 (13.9) | 8563 (14.1) | 9431 (14.2) | 11,352 (13.4) | <.0001 |
Malignancy | 114,562 (30.7) | 15,387 (31.3) | 17,228 (31.5) | 17,999 (31.0) | 18,862 (31.1) | 20,083 (31.2) | 25,003 (29.6) | <.0001 |
locoregional solid tumor | 101,320 (27.1) | 13,735 (28.0) | 15,011 (27.5) | 15,809 (27.2) | 16,688 (27.5) | 17,801 (26.8) | 22,276 (26.3) | <.0001 |
metastasis | 18,938 (5.1) | 2844 (5.8) | 2933 (5.4) | 3044 (5.2) | 3159 (5.2) | 3240 (4.9) | 3718 (4.4) | <.0001 |
hematological malignancies | 16,911 (4.5) | 2105 (4.3) | 2822 (5.2) | 2793 (4.8) | 2783 (4.6) | 2947 (4.4) | 3461 (4.1) | <.0001 |
Elixhauser comorbidity index, Mean (SD) | 18.58 (12.82) | 18.81 (12.87) | 18.88 (12.84) | 18.69 (12.91) | 18.60 (12.92) | 18.53 (12.74) | 18.20 (12.72) | <.0001 |
index < 10 | 101,136 (27.1) | 13,059 (26.6) | 14,332 (26.2) | 15,632 (26.9) | 16,522 (27.3) | 17,990 (27.0) | 23,601 (27.9) | <.0001 |
10 ≤ index < 20 | 106,916 (28.6) | 14,107 (28.7) | 15,518 (28.4) | 16,569 (28.5) | 17,104 (28.2) | 19,076 (28.7) | 24,542 (29.0) | |
20 ≤ index < 30 | 88,271 (23.6) | 11,481 (23.4) | 13,064 (23.9) | 13,749 (23.7) | 14,365 (23.7) | 15,819 (23.8) | 19,793 (23.4) | |
30 ≤ index | 77,216 (20.7) | 10,469 (21.3) | 11,708 (21.4) | 12,142 (20.9) | 12,617 (20.8) | 13,626 (20.5) | 16,654 (19.7) | |
Insurance state, n(%) | ||||||||
National health insurance | 323,252 (86.5) | 42,251 (86.0) | 47,202 (86.4) | 50,264 (86.5) | 52,615 (86.8) | 57,737 (86.8) | 73,183 (86.5) | 0.001 |
Medical aids | 50,287 (13.5) | 6865 (14.0) | 7420 (13.6) | 7828 (13.5) | 7993 (13.2) | 8774 (13.2) | 11,407 (13.5) | |
ICU admission, n(%) | 64,023 (17.1) | 9681 (19.7) | 10,416 (19.1) | 10,529 (18.1) | 10,386 (17.1) | 10,446 (15.7) | 12,565 (14.9) | <.0001 |
Mechanical ventilation, n(%) | 103,531 (27.7) | 16,099 (32.8) | 17,805 (32.6) | 17,633 (30.4) | 16,988 (28.0) | 16,643 (25.0) | 18,363 (21.7) | < 0.001 |
Continuous renal replacement therapy, n(%) | 64,023 (17.1) | 2707 (5.5) | 3237 (5.9) | 3778 (6.5) | 4082 (6.7) | 4571 (6.9) | 5168 (6.1) | < 0.001 |
Type of hospital, n(%) | < 0.001 | |||||||
Tertiary hospital | 147,802 (39.6) | 20,284 (41.3) | 21,776 (39.9) | 23,154 (39.9) | 23,388 (38.6) | 25,597 (38.5) | 33,603 (39.7) | |
General hospital | 225,737 (60.4) | 28,832 (58.7) | 32,846 (60.1) | 34,938 (60.1) | 37,220 (61.4) | 40,914 (61.5) | 50,987 (60.3) |
Prevalence of five comorbidities in patients with sepsis
Incidence of sepsis
In-hospital mortality
In-hospital mortality | Unadjusted | Adjusted | |||
---|---|---|---|---|---|
N = 103,931 | OR (95% CI) | P | OR (95%CI) | P | |
Age (years), n(%) | |||||
18 ≤ age < 60 | 19,359 (21.1) | Reference | Reference | ||
60 ≤ age < 70 | 17,215 (26.2) | 1.326 (1.295–1.357) | < 0.001 | 1.402 (1.365–1.441) | < 0.001 |
70 ≤ age < 80 | 33,048 (28.7) | 1.507 (1.477–1.538) | < 0.001 | 1.910 (1.864–1.957) | < 0.001 |
80 ≤ age | 34,012 (34.1) | 1.937 (1.898–1.977) | < 0.001 | 3.233 (3.153–3.315) | < 0.001 |
Sex, n(%) | |||||
Male | 58,685 (31.4) | Reference | Reference | ||
Female | 45,246 (24.2) | 0.698 (0.688–0.709) | < 0.001 | 0.842 (0.828–0.857) | < 0.001 |
Comorbidities, n(%) | |||||
Hypertension | 55,427 (25.5) | 0.807 (0.795–0.819) | < 0.001 | 0.627 (0.615–0.639) | < 0.001 |
Diabetes | 22,206 (25.2) | 0.839 (0.825–0.854) | < 0.001 | 0.873 (0.854–0.891) | < 0.001 |
Liver cirrhosis | 9550 (34.5) | 1.405 (1.369–1.442) | < 0.001 | 1.613 (1.564–1.664) | < 0.001 |
Chronic kidney disease | 14,305 (28.0) | 1.008 (0.987–1.029) | 0.448 | 1.067 (1.040–1.096) | < 0.001 |
Malignancy | 38,196 (33.3) | 1.470 (1.448–1.458) | < 0.001 | ||
locoregional solid tumor | 33,717 (33.3) | 1.435 (1.413–1.458) | < 0.001 | 1.832 (1.794–1.870) | < 0.001 |
metastasis | 7277 (38.4) | 1.666 (1.616–1.717) | < 0.001 | 2.218 (2.050–2.208) | < 0.001 |
hematological malignancies | 5650 (33.4) | 1.319 (1.276–1.363) | < 0.001 | 2.095 (2.014–2.179) | < 0.001 |
Elixhauser comorbidity index | NA | ||||
index < 10 | Reference | Reference | |||
10 ≤ index < 20 | 1.393 (1.365–1.421) | < 0.001 | 1.156 (1.127–1.183) | < 0.001 | |
20 ≤ index < 30 | 1.552 (1.521–1.584) | < 0.001 | 1.161 (1.121–1.191) | < 0.001 | |
30 ≤ index | 1.466 (1.435–1.498) | < 0.001 | 0.991 (0.963–1.020) | 0.539 | |
Insurance state, n(%) | |||||
National health insurance | 89,052 (27.5) | Reference | Reference | ||
Medical aid | 14,879 (29.6) | 1.105 (1.083–1.128) | < 0.001 | 1.205 (1.177–1.235) | < 0.001 |
ICU admission, n(%) | 25,564 (39.9) | 1.961 (1.927–1.996) | < 0.001 | 0.877 (0.852–0.903) | < 0.001 |
Mechanical ventilation, n(%) | NA | 7.425 (7.306–7.545) | < 0.001 | 8.127 (7.969–8.288) | < 0.001 |
Continuous renal replacement therapy | 15,910 (67.6) | 6.203 (6.030–6.382) | < 0.001 | 3.152 (3.048–3.259) | < 0.001 |
Type of hospital, n(%) | |||||
Tertiary hospitals | 39,875 (27.0) | Reference | Reference | ||
General hospitals | 64,056 (28.4) | 1.092 (1.076–1.108) | < 0.001 | 1.390 (1.359–1.422) | < 0.001 |