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패혈증-3 정의에 따라 진단된 패혈증 및 패혈성 쇼크 환자에서 패혈증 살리기 캠페인 가이드라인 준수 여부와 환자 예후와의 상관 관계 분석

Association between compliance with Surviving Sepsis Campaign guidelines and outcomes among sepsis and septic shock patient in accordance with Sepsis-3 definitions

대한응급의학회지 2020년 31권 1호 p.45 ~ 51
안세중 ( Ahn Se-Joong ) - 고려대학교 안산병원 응급의학과

송주현 ( Song Ju-Hyun ) - 고려대학교 안산병원 응급의학과
문성우 ( Moon Sung-Woo ) - 고려대학교 안산병원 응급의학과
조한진 ( Cho Han-Jin ) - 고려대학교 안산병원 응급의학과
김주영 ( Kim Joo-Yeong ) - 고려대학교 안산병원 응급의학과
박종학 ( Park Jong-Hak ) - 고려대학교 안산병원 응급의학과

Abstract


Objective: The Surviving Sepsis Campaign (SSC) guidelines have been associated with reduced mortality in sepsis patients. On the other hand, previous studies were performed using the Sepsis-2 definitions and past guidelines. This study assessed the association between compliance with the 2016 SSC guidelines and the outcomes of patients with sepsis and septic shock in accordance with the latest Sepsis-3 definitions.

Method: Three hundred and fifteen patients with sepsis and septic shock were enrolled in this study. The patients were stratified according to their compliance with the SSC guidelines bundle. The characteristics and outcomes of the compliance and non-compliance groups were compared. In the overall patients, the risk factors for all-cause mortality were assessed using Cox proportional hazards models.

Results: Among the patients, 172 and 143 patients were in the compliance group and non-compliance group, respectively. The baseline characteristics and disease severity were similar in the two groups. The all-cause mortality rates were 27.3% and 38.5% in the compliance group and non-compliance group, respectively (P=0.035). The all-cause mortality was significantly lower in the compliance group than in the non-compliance group (log-rank test, P=0.025). The risk factors for the all-cause mortality were age (adjusted hazard ratio [aHR], 1.025; 95% confidence interval [CI], 1.008-1.042; P=0.004), septic shock (aHR, 3.14; 95% CI, 1.98-4.98; P<0.001), and lactate levels (aHR, 1.08; 95% CI, 1.03-1.14; P=0.002). The overall compliance with the guidelines protected against all-cause mortality (aHR, 0.66; 95% CI, 0.45-0.98; P=0.040).

Conclusion: Compliance with the SSC guidelines bundle was associated with a lower all-cause mortality among patients with sepsis and septic shock

키워드

Surviving sepsis campaign guidelines; Sepsis; Septic shock; Mortality
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