Supplementary Material for: Trends and Outcomes of Severe Sepsis in Patients on Maintenance Dialysis

Background: Though the incidence of severe sepsis is rising, there is a lack of contemporary information regarding the epidemiology and outcomes of severe sepsis in those on maintenance dialysis. The objectives of this study were to measure the incidence and outcomes of severe sepsis in those on maintenance dialysis. Methods: Using data from Nationwide Inpatient Sample database from 2005 to 2010, we included all hospitalizations of adults with severe sepsis based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Those on maintenance dialysis were identified by ICD-9-CM codes. We calculated incidence of severe sepsis and mortality. We used logistic regression to assess independent effect of maintenance dialysis status on mortality. Results: Of the estimated 5,000,152 hospitalizations with severe sepsis, 322,734 (6.4%) were on maintenance dialysis. The unadjusted incidence of severe sepsis was 145.4 per 1,000 in those on maintenance dialysis in comparison to 3.5 per 1,000 in the general population. Mortality was higher in those with severe sepsis (30.3 vs. 26.2%; p < 0.001). Maintenance dialysis is an independent predictor of death in those with severe sepsis (OR 1.26; 95% CI 1.23-1.29). Conclusions: Hospitalizations with severe sepsis are more prevalent and associated with poor outcomes in those on maintenance dialysis.研究背景：尽管重症脓毒症的发病率呈上升趋势，但目前尚缺乏关于维持性透析患者重症脓毒症的流行病学特征与临床转归的最新研究数据。本研究旨在明确维持性透析患者重症脓毒症的发病率与临床结局。 研究方法：本研究采用2005至2010年美国全国住院患者样本（Nationwide Inpatient Sample, NIS）数据库数据，依据《国际疾病分类第9版临床修订版（International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM）》编码筛选所有重症脓毒症成人住院病例，并通过ICD-9-CM编码识别维持性透析患者。本研究计算了重症脓毒症的发病率与死亡率，并采用logistic回归分析评估维持性透析状态对患者死亡率的独立影响。 研究结果：在估算的5000152例重症脓毒症住院病例中，322734例（6.4%）为维持性透析患者。维持性透析群体中重症脓毒症的粗发病率为145.4/1000，而普通人群仅为3.5/1000。重症脓毒症患者的死亡率更高（30.3% vs. 26.2%；p < 0.001）。维持性透析是重症脓毒症患者死亡的独立预测因素（比值比OR=1.26；95%置信区间CI：1.23~1.29）。 研究结论：维持性透析患者的重症脓毒症住院率更高，且该群体罹患重症脓毒症后临床转归更差。