Association of annual hospital septic shock case volume and hospital mortality.
Case volume
Hospital mortality
Septic shock
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
04 06 2022
04 06 2022
Historique:
received:
20
01
2022
accepted:
26
05
2022
entrez:
6
6
2022
pubmed:
7
6
2022
medline:
9
6
2022
Statut:
epublish
Résumé
The burden of sepsis remains high in China. The relationship between case volume and hospital mortality among patients with septic shock, the most severe complication of sepsis, is unknown in China. In this retrospective cohort study, we analyzed surveillance data from a national quality improvement program in intensive care units (ICUs) in China in 2020. Association between septic shock case volume and hospital mortality was analyzed using multivariate linear regression and restricted cubic splines. We enrolled a total of 134,046 septic shock cases in ICUs from 1902 hospitals in China during 2020. In this septic shock cohort, the median septic shock volume per hospital was 33 cases (interquartile range 14-76 cases), 41.4% were female, and more than half of the patients were over 61 years old, with average hospital mortality of 21.2%. An increase in case volume was associated with improved survival among septic shock cases. In the linear regression model, the highest quartile of septic shock volume was associated with lower hospital mortality compared with the lowest quartile (β - 0.86; 95% CI - 0.98, - 0.74; p < 0.001). Similar differences were found in hospitals of respective geographic locations and hospital levels. With case volume modeled as a continuous variable in a restricted cubic spline, a lower volume threshold of 40 cases before which a substantial reduction of the hospital mortality rate was observed. The findings suggest that hospitals with higher septic shock case volume have lower hospital mortality in China. Further research is needed to explain the mechanism of this volume-outcome relationship.
Sections du résumé
BACKGROUND
The burden of sepsis remains high in China. The relationship between case volume and hospital mortality among patients with septic shock, the most severe complication of sepsis, is unknown in China.
METHODS
In this retrospective cohort study, we analyzed surveillance data from a national quality improvement program in intensive care units (ICUs) in China in 2020. Association between septic shock case volume and hospital mortality was analyzed using multivariate linear regression and restricted cubic splines.
RESULTS
We enrolled a total of 134,046 septic shock cases in ICUs from 1902 hospitals in China during 2020. In this septic shock cohort, the median septic shock volume per hospital was 33 cases (interquartile range 14-76 cases), 41.4% were female, and more than half of the patients were over 61 years old, with average hospital mortality of 21.2%. An increase in case volume was associated with improved survival among septic shock cases. In the linear regression model, the highest quartile of septic shock volume was associated with lower hospital mortality compared with the lowest quartile (β - 0.86; 95% CI - 0.98, - 0.74; p < 0.001). Similar differences were found in hospitals of respective geographic locations and hospital levels. With case volume modeled as a continuous variable in a restricted cubic spline, a lower volume threshold of 40 cases before which a substantial reduction of the hospital mortality rate was observed.
CONCLUSIONS
The findings suggest that hospitals with higher septic shock case volume have lower hospital mortality in China. Further research is needed to explain the mechanism of this volume-outcome relationship.
Identifiants
pubmed: 35659338
doi: 10.1186/s13054-022-04035-8
pii: 10.1186/s13054-022-04035-8
pmc: PMC9166431
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
161Subventions
Organisme : Beijing Municipal Science and Technology Commission
ID : Z201100005520037
Organisme : Ministry of Science and Technology of the People's Republic of China
ID : 2021YFC2500800
Organisme : Chinese Academy of Medical Sciences
ID : 2021-I2M-1-062
Informations de copyright
© 2022. The Author(s).
Références
JAMA Netw Open. 2021 Jun 1;4(6):e2115305
pubmed: 34185067
Intensive Care Med. 2020 Aug;46(8):1552-1562
pubmed: 32572531
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2006 Jul;18(7):387-8
pubmed: 16903027
Am J Respir Crit Care Med. 2017 Oct 1;196(7):856-863
pubmed: 28345952
Am Heart J. 2021 Feb;232:94-104
pubmed: 33257304
Int J Equity Health. 2016 Nov 8;15(1):179
pubmed: 27821181
N Engl J Med. 2005 Jul 28;353(4):349-61
pubmed: 16049209
Crit Care Med. 2017 Jun;45(6):980-988
pubmed: 28350646
Lancet. 2019 Sep 28;394(10204):1192-1204
pubmed: 31571602
Intensive Care Med. 2018 Jul;44(7):1071-1080
pubmed: 29846748
Lancet. 2005 Jan 1-7;365(9453):63-78
pubmed: 15639681
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
Int J Environ Res Public Health. 2018 Dec 25;16(1):
pubmed: 30585243
N Engl J Med. 1999 May 27;340(21):1640-8
pubmed: 10341277
JAMA. 2001 Mar 7;285(9):1164-71
pubmed: 11231745
JAMA. 2019 Jul 16;322(3):240-250
pubmed: 31310298
JAMA. 2000 Mar 1;283(9):1159-66
pubmed: 10703778
Intensive Care Med. 2020 Aug;46(8):1536-1551
pubmed: 32591853
Intensive Care Med. 2013 Feb;39(2):165-228
pubmed: 23361625
Lancet. 2020 Jan 18;395(10219):200-211
pubmed: 31954465
Crit Care. 2020 Mar 4;24(1):73
pubmed: 32131872
Am J Respir Crit Care Med. 2014 Sep 15;190(6):665-74
pubmed: 25117723
Intensive Care Med. 2014 Nov;40(11):1623-33
pubmed: 25270221
Crit Care Med. 2011 Jul;39(7):1675-82
pubmed: 21685740
Chest. 2017 Feb;151(2):278-285
pubmed: 27452768
Am J Respir Crit Care Med. 2012 Dec 15;186(12):1264-71
pubmed: 23087028
PLoS One. 2015 Jan 24;10(1):e0116949
pubmed: 25617837