A multicenter, prospective evaluation of quality of care and mortality in Japan based on the Surviving Sepsis Campaign guidelines

作者：Fujishima Seitaro^*; Gando Satoshi; Saitoh Daizoh; Mayumi Toshihiko; Kushimoto Shigeki; Shiraishi Shin ichiro; Ogura Hiroshi; Takuma Kiyotsugu; Kotani Joji; Ikeda Hiroto; Yamashita Norio; Suzuki Koichiro; Tsuruta Ryosuke; Takeyama Naoshi; Araki Tsunetoshi; Suzuki Yasushi; Miki Yasuo; Yamaguchi Yoshihiro; Aikawa Naoki

来源：Journal of Infection and Chemotherapy, 2014, 20(1-2): 115-120.

DOI：10.1016/j.jiac.2013.09.003

• Surviving Sepsis Campaign guidelines
• Septic shock
• Quality indicator
• Intensive care unit
• Emergency department
• Japanese association for acute medicine

To elucidate the standard Surviving Sepsis Campaign (SSC) guidelines-based quality of care and mortality related to severe sepsis in Japan, we conducted a multicenter, prospective, observational study using a new web-based database between June 1, 2010, and December 31, 2011. A total of 1104 patients with severe sepsis were enrolled from 39 Japanese emergency and critical care centers. All-cause hospital mortality was 29.3% in patients with severe sepsis and 40.7% in patients with septic shock. Pulmonary, renal, hepatic, and hematological dysfunctions were associated with significantly higher mortality, and hematological dysfunction, especially coagulopathy, was associated with the highest odds ratio for mortality. Compliance with severe sepsis bundles in our study was generally low compared with that in a previous international sepsis registry study, and glycemic control was associated with lowest odds ratio for mortality. Despite higher complication rates of multiple organ dysfunction syndrome and low compliance with severe sepsis bundles on the whole, mortality in our study was similar to that in the international sepsis registry study. From these results, we concluded that our prospective multicenter study was successful in evaluating SSC guidelines-based standard quality of care and mortality related to severe sepsis in Japan. Although mortality in Japan was equivalent to that reported worldwide in the above-mentioned international sepsis registry study, compliance with severe sepsis bundles was low. Thus, there is scope for improvement in the initial treatment of severe sepsis and septic shock in Japanese emergency and critical care centers.

• 出版日期2014-2