BACKGROUND The burden of sepsis represents a global health care problem. We aimed to assess the case fatality rate (CFR) and its predictors in subjects with sepsis admitted to a general Italian hospital from 2009 to 2016, stratified by risk score. METHODS We performed a retrospective analysis of all sepsis-related hospitalizations after Emergency Department (ED) visit in a public Italian hospital in an 8-year period. A risk score to predict CFR was computed by logistic regression analysis of selected variables in a training set (2009-2012), and then confirmed in the whole study population. A trend analysis of CFR during the study period was performed dividing patient as high-risk (upper tertile of risk score) or low-risk. RESULTS Two thousand four hundred ninety-two subjects were included. Over time the incidental admission rate (no. of sepsis-related admissions per 100 total admissions) increased from 4.1% (2009-2010) to 5.4% (2015-2016); P < 0.001, accompanied by a reduced CFR (from 38.0 to 18.4%; P < 0.001). A group of 10 variables (admission to intensive care unit, cardio-vascular dysfunction, HIV infection, diabetes, age ≥ 80 years, respiratory diseases, number of organ dysfunction, digestive diseases, dementia and cancer) were selected by the logistic model to predict CFR with good accuracy: AUC 0.873 [0.009]. Along the years CFR decreased from 31.8% (2009-2010) to 25.0% (2015-2016); P = 0.007. The relative proportion of subjects ≥80 years (overall, 52.9% of cases) and classified as high-risk did not change along the years. CFR decreased only in low-risk subjects (from 13.3 to 5.2%; P < 0.001), and particularly in those aged ≥80 (from 18.2 to 6.6%; P = 0.003), but not in high-risk individuals (from 69.9 to 64.2%; P = 0.713). CONCLUSION Between 2009 and 2016 the incidence of sepsis-related hospitalization increased in a general Italian hospital, with a downward trend in CFR, only limited to low-risk patients and particularly to subjects ≥80 years.

中文翻译：

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急诊科中败血症的老年受试者：病死率趋势分析。

背景技术败血症的负担代表了全球卫生保健问题。我们旨在评估2009年至2016年在意大利一家普通医院就诊的败血症患者的病死率（CFR）及其预测因子，并按风险评分进行分层。方法我们对急诊部（ED）在意大利一家公立医院进行了为期8年的访视后所有败血症相关的住院治疗进行了回顾性分析。通过对训练集中所选变量的逻辑回归分析（2009-2012年）计算出预测CFR的风险评分，然后在整个研究人群中得到确认。在研究期间对CFR进行趋势分析，将患者分为高风险（风险评分的上三分位数）或低风险。结果纳入了942名受试者。随着时间的流逝，偶然入学率（否。每100例总脓毒症相关的住院人数）从4.1％（2009-2010年）增加到5.4％（2015-2016年）; P <0.001，伴有CFR降低（从38.0％降至18.4％； P <0.001）。通过逻辑模型选择了10个变量（重症监护病房入院，心血管功能障碍，HIV感染，糖尿病，年龄≥80岁，呼吸系统疾病，器官功能障碍数，消化系统疾病，痴呆和癌症）的一组变量进行预测CFR精度高：AUC 0.873 [0.009]。多年来，CFR从31.8％（2009-2010）降至25.0％（2015-2016）; P ＝ 0.007。≥80岁（占总病例的52.9％）且被分类为高风险的受试者的相对比例多年来没有变化。CFR仅在低风险受试者中下降（从13.3％下降到5.2％； P <0.001），尤其是在80岁以上的人群中（从18.2％下降到6.6％； P = 0.003），但高危人群则不然（从69.9％降至64.2％； P = 0.713）。结论2009年至2016年间，意大利一家综合医院的脓毒症相关住院率有所上升，CFR呈下降趋势，仅限于低危患者，尤其是≥80岁的患者。