The Lancet Infectious Diseases ( IF 56.3 ) Pub Date : 2017-08-17 , DOI: 10.1016/s1473-3099(17)30322-5 Flavia R Machado , Alexandre Biasi Cavalcanti , Fernando Augusto Bozza , Elaine M Ferreira , Fernanda Sousa Angotti Carrara , Juliana Lubarino Sousa , Noemi Caixeta , Reinaldo Salomao , Derek C Angus , Luciano Cesar Pontes Azevedo , S R Zajac , M V Bley , M V Bley , A Scazufca , P Rosateli , T Reis , A Nogueira Junior , P A Nunes Neto , I L S Filho , H Lima , M Vieira , M Zanchet , I Ferreira , R Miguita , G M Petisco , G A Westphal , J R P Santos , V Damasceno , J T dos Santos , F Fernandes , EP Almeida , M Lemos , M F A Lima , R Camacho , A Ribeiro , M O G Douglas , G A Mattei , E A Junior , P Ferreira , H R M P Rabelo , S P S Pinto , L E Fontes , D Machado , M Guitzel , M Lucio , C N P Conceição , A Barros , D Salgado , V C Veiga , S S O Rojas , V C Veiga , S S O Rojas , KM de Paula , R Hatum , L Fraenkel , W N Viana , A P G Santos , L Rabello , L Tanaka , M Uchoa , M D Moura , H Gneco , M F Buarque , K Monteiro , A P Nassar , E Koterba , M J Teixeira , A L E Falcão , V G S Pinto , J M M Junior , A L Gut , L M Stefano , M Damasceno , M V Lontra , C Cozzani , E B Sobrinho , S G Lage , L Kopel , N C M Youssef , L C Sanches , C P Amendola , C Kmohan , C B Silva , L Schifelbain , E Bellotto , P Viecili , L Azevedo , L Monteiro , S Vieira , A M Abrão , A P Moraes , H Insaurrale , M Gadelha , D Marisa , R N Diniz , E R Romano , S Luzzi , E Rezende , M C Filho , R H F C Martins , F B Carvalho , G C Moreira , J Paula , F Fernandes , F Haag , FS Lucena , R S Machado , W O Filho , L O Cavalcante , H Carvalho Filho , G S Lima , J N Trombka , E C Machado , M P Bainy , C H Ramos , C Hoppe , G D Luckmeyer , C Vogas , M M Thompson , R K Sousa , R Fernandes , E Lourenço , G L Peixoto , A Mocelin , M M L Silva , J S A Neto , C Villela , S L Mendonça , S C Prado , R Goulart , J J L Duarte , H A O Junior , J N Andrade , L F Souza , L Fernandes , M L Neto , S S Fernandes , F Amâncio , J C Versiani , F Pitanga , M B Alcantara , C C Reiff , R Rosenblat , M S Nobrega , M L F S Nobrega , G Costa , N Assunção , E P Almeida , L Neder , R Almeida , J Fuck , R M Souza , A G Ribeiro , A A G Alves , S H C Carvalho , M Arbex , E C Oliveira , F B Carvalho , R S Melo , K Conde , N Q Abreu , C L T Melo , A A Carvalho , M C Filho , R Lannes , H Missaka , A H Furtado , A A Peixoto , I Maia , M P Pincelli , R Camacho , M P Yunes , A N Pessoa , S Figueiredo , F A Botoni , C T Cunha , F A Olson , R Franco , A F Bemfica , M S Nobrega , A D F Junior , E L A Ferreira , O Messeder , R Passos , J A Lira , C A Vilela , S M D Junior , C S Ferreira , O P J A Muller , R Perreira dos Santos , P Rubini , D Monteiro , L E Rodrigues , G F Ruivo , M C Gomes , E Egito , M G Assef , M A M Lima , A F Borges , M Gadelha , S Jezler , C Mendes , P C Gottardo , R Lima , C M F Filho , V P Campagnucci , I Solino , A P Lorca , A P Lorca , G M Rodrigues , K B Gerent , O Barbosa , G T Henriques Filho , E Troncoso , A Ventura , M A Silva , J G Houly , J P M Pimentel , R A Ramos , F Gianini , B Casemiro , E M Pinto , G A Silva , M Sebold , E Vieira , R Ferreira , L A Gomes , W J Lovato , W Dantas , L Ishy , W Dantas , L Ishy , J Moreira , I Gagliardi , L O Goes , L S Vendrame , H P Guimarães , A Gois , F R Machado , M Rodrigues , P C B Vieira , W Bittencourt , E Melnick , M Schneider , L Rezegue , N J M Nogueira , L Azevedo , E P Godinho , B F Mazza , L E Paciencia , S Ferraz , C R A Imamura , J Tavares , J C Santos , E Vale , J Mugait Filho , L A Tannous , P G D João , C T I Geral , D Salgado , A P Matera , M Matsui , E Eberhart Neto , B V Pinheiro , E V Carvalho , H Matos , M Lippi , A L Campos , D C Albuquerque , D Monteiro , D Castiglioni , G S Silva , S Cunha , E Novello , M E B Silva , C Grion , J Festti , C Grion , J Festti , C R A Souza , G C Mecatti , E B Junqueira , R S Dutra , G B Mirachi , D A Mendes , E M F Moura , I F Silva , M G P Mota , T Carneiro , A Celso , A Réa-Neto , M C Oliveira , A Japiassú , P P Castro , H J M Costa , A V Rolim , D Rocha , C Righy , C Righy , V Santos , B Fernandino , A L Pereira , V L D Rego , M M L Silva , L A Melo , L Guilherme , H Chagas Ferro , F J L Silva , H V C J Carrasco , S El-Fakouri , J Alvarez , D de Castro , P M Shiavetto , S R Gallate , E Thomé Filho , S G Veneziano , W O Filho , P Antoniazzi , W H Filho , P Sadala , C Balbino , G Moreno , M S F Dias , R P Lopez , M L Rodrigues , J Terceiro , M F Serpa , L Santos , W O Filho , M M Lippi , S R Zajac , M V Bley , M V Bley , A Scazufca , P Rosateli , T Reis , A Nogueira Junior , P A Nunes Neto , I L S Filho , H Lima , M Vieira , M Zanchet , I Ferreira , R Miguita , G M Petisco , G A Westphal , J R P Santos , V Damasceno , J T dos Santos , F Fernandes , EP Almeida , M Lemos , M F A Lima , R Camacho , A Ribeiro , M O G Douglas , G A Mattei , E A Junior , P Ferreira , H R M P Rabelo , S P S Pinto , L E Fontes , D Machado , M Guitzel , M Lucio , C N P Conceição , A Barros , D Salgado , V C Veiga , S S O Rojas , V C Veiga , S S O Rojas , KM de Paula , R Hatum , L Fraenkel , W N Viana , A P G Santos , L Rabello , L Tanaka , M Uchoa , M D Moura , H Gneco , M F Buarque , K Monteiro , A P Nassar , E Koterba , M J Teixeira , A L E Falcão , V G S Pinto , J M M Junior , A L Gut , L M Stefano , M Damasceno , M V Lontra , C Cozzani , E B Sobrinho , S G Lage , L Kopel , N C M Youssef , L C Sanches , C P Amendola , C Kmohan , C B Silva , L Schifelbain , E Bellotto , P Viecili , L Azevedo , L Monteiro , S Vieira , A M Abrão , A P Moraes , H Insaurrale , M Gadelha , D Marisa , R N Diniz , E R Romano , S Luzzi , E Rezende , M C Filho , R H F C Martins , F B Carvalho , G C Moreira , J Paula , F Fernandes , F Haag , FS Lucena , R S Machado , W O Filho , L O Cavalcante , H Carvalho Filho , G S Lima , J N Trombka , E C Machado , M P Bainy , C H Ramos , C Hoppe , G D Luckmeyer , C Vogas , M M Thompson , R K Sousa , R Fernandes , E Lourenço , G L Peixoto , A Mocelin , M M L Silva , J S A Neto , C Villela , S L Mendonça , S C Prado , R Goulart , J J L Duarte , H A O Junior , J N Andrade , L F Souza , L Fernandes , M L Neto , S S Fernandes , F Amâncio , J C Versiani , F Pitanga , M B Alcantara , C C Reiff , R Rosenblat , M S Nobrega , M L F S Nobrega , G Costa , N Assunção , E P Almeida , L Neder , R Almeida , J Fuck , R M Souza , A G Ribeiro , A A G Alves , S H C Carvalho , M Arbex , E C Oliveira , F B Carvalho , R S Melo , K Conde , N Q Abreu , C L T Melo , A A Carvalho , M C Filho , R Lannes , H Missaka , A H Furtado , A A Peixoto , I Maia , M P Pincelli , R Camacho , M P Yunes , A N Pessoa , S Figueiredo , F A Botoni , C T Cunha , F A Olson , R Franco , A F Bemfica , M S Nobrega , A D F Junior , E L A Ferreira , O Messeder , R Passos , J A Lira , C A Vilela , S M D Junior , C S Ferreira , O P J A Muller , R Perreira dos Santos , P Rubini , D Monteiro , L E Rodrigues , G F Ruivo , M C Gomes , E Egito , M G Assef , M A M Lima , A F Borges , M Gadelha , S Jezler , C Mendes , P C Gottardo , R Lima , C M F Filho , V P Campagnucci , I Solino , A P Lorca , A P Lorca , G M Rodrigues , K B Gerent , O Barbosa , G T Henriques Filho , E Troncoso , A Ventura , M A Silva , J G Houly , J P M Pimentel , R A Ramos , F Gianini , B Casemiro , E M Pinto , G A Silva , M Sebold , E Vieira , R Ferreira , L A Gomes , W J Lovato , W Dantas , L Ishy , W Dantas , L Ishy , J Moreira , I Gagliardi , L O Goes , L S Vendrame , H P Guimarães , A Gois , F R Machado , M Rodrigues , P C B Vieira , W Bittencourt , E Melnick , M Schneider , L Rezegue , N J M Nogueira , L Azevedo , E P Godinho , B F Mazza , L E Paciencia , S Ferraz , C R A Imamura , J Tavares , J C Santos , E Vale , J Mugait Filho , L A Tannous , P G D João , C T I Geral , D Salgado , A P Matera , M Matsui , E Eberhart Neto , B V Pinheiro , E V Carvalho , H Matos , M Lippi , A L Campos , D C Albuquerque , D Monteiro , D Castiglioni , G S Silva , S Cunha , E Novello , M E B Silva , C Grion , J Festti , C Grion , J Festti , C R A Souza , G C Mecatti , E B Junqueira , R S Dutra , G B Mirachi , D A Mendes , E M F Moura , I F Silva , M G P Mota , T Carneiro , A Celso , A Réa-Neto , M C Oliveira , A Japiassú , P P Castro , H J M Costa , A V Rolim , D Rocha , C Righy , C Righy , V Santos , B Fernandino , A L Pereira , V L D Rego , M M L Silva , L A Melo , L Guilherme , H Chagas Ferro , F J L Silva , H V C J Carrasco , S El-Fakouri , J Alvarez , D de Castro , P M Shiavetto , S R Gallate , E Thomé Filho , S G Veneziano , W O Filho , P Antoniazzi , W H Filho , P Sadala , C Balbino , G Moreno , M S F Dias , R P Lopez , M L Rodrigues , J Terceiro , M F Serpa , L Santos , W O Filho , M M Lippi
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Background
The sepsis burden on acute care services in middle-income countries is a cause for concern. We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome.
Methods
We did a 1-day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample. We produced a sampling frame initially stratified by geographical region. Each stratum was then stratified by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata. In each stratum we selected a random sample of ICUs so as to enrol the total required beds in 1690 Brazilian adult ICUs. We followed up patients until hospital discharge censored at 60 days, estimated incidence from prevalence and length of stay, and generated national estimates. We assessed mortality prognostic factors using random-effects logistic regression models.
Findings
On Feb 27, 2014, 227 (72%) of 317 ICUs that were randomly selected provided data on 2632 patients, of whom 794 had sepsis (30·2 septic patients per 100 ICU beds, 95% CI 28·4–31·9). The ICU sepsis incidence was 36·3 per 1000 patient-days (95% CI 29·8–44·0) and mortality was observed in 439 (55·7%) of 788 patients (95% CI 52·2–59·2). Low availability of resources (odds ratio [OR] 1·67, 95% CI 1·02–2·75, p=0·045) and adequacy of treatment (OR 0·56, 0·37–0·84, p=0·006) were independently associated with mortality. The projected incidence rate is 290 per 100 000 population (95% CI 237·9–351·2) of adult cases of ICU-treated sepsis per year, which yields about 420 000 cases annually, of whom 230 000 die in hospital.
Interpretation
The incidence, prevalence, and mortality of ICU-treated sepsis is high in Brazil. Outcome varies considerably, and is associated with access to adequate resources and treatment. Our results show the burden of sepsis in resource-limited settings, highlighting the need to establish programmes aiming for sepsis prevention, early diagnosis, and adequate treatment.
Funding
Fundação de Apoio a Pesquisa do Estado de São Paulo (FAPESP).
中文翻译：
巴西重症监护病房败血症的流行病学（脓毒症患病率评估数据库，SPREAD）：一项观察性研究
背景
中等收入国家败血症给急诊服务带来的负担令人担忧。我们估计了成人巴西重症监护病房（ICU）败血症的发生率，患病率和死亡率，以及ICU组织因素与结局的关系。
方法
我们在全国代表性的伪随机样本中对ICU败血症患者进行了为期1天的患病率研究。我们制作了一个最初按地理区域分层的抽样框架。然后，按医院的主要收入来源（服务于普通市民与私人保险的个人）和ICU的大小（十张或更少床位到十张以上床位）对每个阶层进行分层，最终产生40个阶层。在每个阶层中，我们选择了一个ICU随机样本，以登记1690个巴西成人ICU中所需的床位总数。我们对患者进行随访，直到在60天检查出院，根据患病率和住院时间估算发病率，并得出全国估算值。我们使用随机效应逻辑回归模型评估了死亡率预后因素。
发现
2014年2月27日，随机选择的317个ICU中有227个（72％）提供了2632例患者的数据，其中794例患有败血症（每100个ICU病床有30·2名败血症患者，95％CI 28·4–31·9 ）。ICU败血症发生率为每1000名患者日36·3（95％CI 29·8–44·0），并且在788名患者中有439（55·7％）观察到死亡率（95％CI 52·2–59· 2）。资源利用率低（赔率[OR] 1·67、95％CI 1·02–2·75，p = 0·045）和治疗充分性（OR 0·56、0·37-0·84，p = 0·006）与死亡率独立相关。预计每年的发病率是每10万人口中290例（95％CI 237·9–351·2），由ICU治疗的脓毒症成年病例，每年产生约420,000例病例，其中23万人死于医院。
解释
在巴西，ICU治疗败血症的发生率，患病率和死亡率很高。结果差异很大，并与获得足够的资源和治疗有关。我们的结果显示了在资源有限的环境中脓毒症的负担，突显了建立针对脓毒症预防，早期诊断和适当治疗的计划的必要性。
资金
圣保罗埃斯多·德·波多黎各的阿波约基金会（FAPESP）。
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