2021年 · 第101卷第25期

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. However, as a syndrome caused by underlying infection, the global burden of disease research data is still relatively limited. This study is the first to use data from the Global Burden of Disease Study (GBD2017) to assess the incidence and mortality of sepsis globally, in different regions and countries. The study included 282 potential causes of death from sepsis in 109 million death records in GBD2017, using a mixed-effect linear regression model to model different factors such as age, sex, location, and year (1990 – 2017). The results showed that a total of about 48.9 million sepsis events were reported globally in 2017, of which 11 million related deaths occurred, accounting for 19.7% of all deaths globally. Age-standardized sepsis rates decreased by 37.0% and mortality by 52.8% in 2017 compared to 1990. Despite the decline in age-standardized morbidity and mortality, sepsis remains a major threat to global health, and the burden of disease is particularly acute in sub-Saharan Africa.

Mortality in patients with cardiogenic shock due to sepsis remains high, and this study evaluated the supportive role of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with septic cardiogenic shock who are not effective with conventional therapy. The study included 82 adult septic cardiogenic shock patients treated with VA-ECMO and 130 control patients who did not receive ECMO in 5 ECMO centers worldwide. All patients had severe cardiac dysfunction [cardiac index (CI) ≤3 L/ (min·m²)] or left ventricular ejection fraction (LVEF) ≤35%] and hemodynamic impairment [positive inotropic drug score ≥75 μ g/ (kg min), lactic acid ≥4 mmol/L]. The primary endpoint of the study was 90-day survival. The results showed that at the baseline level of the disease, the treatment group was more severe than the control group: cardiac dysfunction [mean CI 1.5 L/ (min·m²) ratio 2.2 L/ (min·m²), LVEF: 17% vs. 27%]; Hemodynamic impairment [positive inotropic drug score 279 μ g/ (kg·min) vs 145 μ g/ (kg·min), lactate concentration 8.9 mmol/L vs 6.5 mmol/L]; Organ failure (Sequential Organ Failure Assessment Score 17 vs 13). However, the 90-day survival rate of patients treated with VA-ECMO was significantly higher than that of controls (60% vs. 25%). After propensity score weighting, ECMO treatment still improved survival (51% vs. 14%) and significantly improved patient lactate and catecholamine clearance. Of the 49 patients who survived VA-ECMO, 32 had participated in the Health Survey Short Form (SF-36) assessment at follow-up 1 year later and had a good health assessment. The results of this study suggest that VA-ECMO significantly improves survival in patients with severe septic cardiogenic shock compared to controls who did not receive ECMO.