| アブストラクト | BACKGROUND: Clinical guidelines for the management of sepsis have accelerated the utilization of central venous catheterization (CVC). However, risks associated with CVC may be high in the initial phase of severe sepsis because of patient instability. The timing of CVC itself has not been fully evaluated. Therefore, we aimed to assess the association between CVC in the initial care of patients with severe sepsis and corresponding mortality rates. PATIENTS AND METHODS: We conducted a nationwide retrospective analysis using the Japanese Diagnosis Procedure Combination database from April 1, 2014 to March 31, 2016. We identified patients who received CVC within 30 days from hospital admission. We compared the 30-day mortality between two groups: patients who received CVC within 2 days (early) after admission and those who received CVC 3 or more days (delayed) after admission, using marginal structural models with inverse probability treatment weighting. RESULTS: We identified 6,028 eligible patients from 911 hospitals among 27,497 patients with severe sepsis for this study; 4,544 (75.4%) received early CVC. Patients with early CVC had poor prognostic baselines and received more intense treatment than patients with delayed CVC. After adjusting for baseline and time-dependent treatment variables, we found that there were no significant differences between patients who received CVC within 2 days after admission and those who received CVC 3 or more days after admission (hazard ratio 0.83, 95% confidence interval 0.62-1.10). CONCLUSIONS: Among patients with severe sepsis, early CVC was not associated with improved in-hospital mortality rates. |
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| ジャーナル名 | Shock (Augusta, Ga.) |
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| Pubmed追加日 | 2020/9/30 |
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| 投稿者 | Edakubo, Shunsuke; Inoue, Norihiko; Fushimi, Kiyohide |
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| 組織名 | Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School, Tokyo, Japan.;Department of Information Technology and Management, The National Center of Child;Health and Development, Tokyo, Japan.;Department of Clinical Data Management and Research, Clinical Research Center,;National Hospital Organization, Tokyo, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/32991796/ |
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