An Epidemiological Study Of Sepsis Based On The Permanent Population In Yuetan Street, Beijing

Background:First,We aimed to evaluate the accuracy of quick Sequential(sepsis-related)Organ Failure Assessment(qSOFA)for the diagnosis of sepsis-3,and to analyze the prognosis of infected patients in wards over-diagnosed with qSOFA but missed by sepsis-3,and those missed by qSOFA but in accordance with sepsis-3 criteria.We also intended to validate the performance of qSOFA as one predictor of outcome in patients with suspicion of infection.Second,new diagnostic criteria for sepsis(sepsis-3)have been promulgated for more than three years.The study for the epidemiology of sepsis-3 remains scarce.The purpose of this study was to describe incidence and outcome of sepsis-3 in Yuetan Subdistrict of Beijing and to estimate the incidence rate of sepsis-3 in China.Methods:We reviewed the medical records of 1716 adult patients with infection who were hospitalized from July 1st,2012 to June 30th,2014 in the Yuetan subdistrict of Beijing,China.Based on the sepsis-3 criteria and qSOFA score proposed by the Third International Consensus Definitions for Sepsis and Septic Shock,these patients were categorized into four groups:qSOFA(-)sepsis(-),qSOFA(+)sepsis(-),qSOFA(-)sepsis(+),and qSOFA(+)sepsis(+).Multivariate logistic regression analysis was used to determine the independent risk factors for in-hospital mortality.The area under the receiver operating characteristic curves(AUROCs)of the qSOFA(+)group were compared with the sepsis(+)group for in-hospital mortality,ICU admission,and invasive ventilation.For the epidemiological study of sepsis-3,patients with sepsis-3 were included in the analysis.Continuous variables were presented as median and interquartile range(IQR),and were compared using the Wilcoxon rank sum test.Categorical variables were presented as a percentage of the group from which they were derived,and compared by the use of Chi-square test or Fisher's exact test.Incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census.Results:Among the 1,716 patients with infection,there were 935 patients(54.5%)with sepsis,and 640 patients(37.3%)with qSOFA=2.There were 610 patients in the qSOFA(-)sepsis(-)group,171 in the qSOFA(+)sepsis(-)group,466 in the qSOFA(-)sepsis(+)group,and 469 in the qSOFA(+)sepsis(+)group.In the logistic regression analysis,increasing age,bedridden status,and complicated malignancy were all independent risk factors of hospital mortality.Sepsis and qSOFA(?)2 were also independent risk factors of hospital mortality,with an adjusted OR of 3.85(95%CI 2.70-5.50)and 13.92(95%CI 9.87-16.93)respectively.qSOFA had a sensitivity of 50.2%and a specificity of 78.1%for sepsis-3.The false-positive[qSOFA(+)sepsis(-)]group had 38 patients(22.2%)die during hospitalization,and an adjusted OR of 9.20(95%CI 4.86-17.38).In addition,the false-negative[qSOFA(-)sepsis(+)]group had a hospital mortality rate of 7.3%(34/466)and an adjusted OR of 2.59(95%CI 1.39-4.83).In comparison,patients meeting neither qSOFA nor sepsis criteria had the lowest hospital mortality(2.6%[16/610]),whereas patients with both qSOFA(?)2 and sepsis had the highest hospital mortality(56.5%[265/469]),with an adjusted OR of 42.02(95%CI 24.31-72.64).The discrimination of in-hospital mortality using qSOFA(AUROC,0.846;95%CI,0.824-0.868)was greater compared with Sepsis-3 criteria(AUROC,0.834;95%CI,0.805-0.863;p<0.001).The crude annual incidence rate of sepsis-3 in Yuetan Subdistrict was 363 cases per 100,000 population,corresponding to standardized incidence rates of 236 cases per 100,000 population per year,respectively.The incidence rate and mortality rate of sepsis-3 were significantly higher in males,elderly people and patients with more comorbidities.The overall hospital mortality rate of sepsis-3 was 32.0%,yielding a standardized mortality rate of 67 cases per 100,000 population per year.In addition,the incidence rate of sepsis-3 exhibited significant seasonal variation,being highest in winter(December,January and February)and lowest in autumn(September,October,and November).Case fatality rate showed no gender difference between men and women.Conclusions:In our analysis,the sensitivity(Se)of qSOFA for the diagnosis of sepsis was lower,and qSOFA score(?)2 might identify a group of patients at a higher risk of mortality,regardless of being septic or not.We found the standardized incidence rate of 236 cases per 100,000 person-years for sepsis-3,which was more common in males and elderly population.This corresponded to about 2.5 million new cases of sepsis-3 per year,resulting in more than 700,000 deaths in China.