Shock in China 2018 (SIC-study): a cross-sectional survey

Abstract

Background: Shock is a critical illness that seriously threatens the lives of patients. This study explains the epidemiology of shock, mortality of shock, and identify factors that related to hospital death.

Methods: This is a multi-centre cross-sectional survey, which included 1,064 tertiary hospitals in 31 provinces, municipalities, and autonomous regions across China mainland. Totally 289,428 patients who diagnosed with shock based on the ICD-10 abstracted from the Hospital Quality Monitoring System (HQMS) in 2018, a national database administrated by National Health Commission of the PRC.

Results: Patients diagnosed with shock were screened and classified according to the type of shock. Regression analysis was used to identify factors that related to death. A total of 79,668,156 medical records were included in HQMS in 2018, from which a total of 289,428 records with shock were identified. Hypovolemic shock occurred in 128,436 cases (44.38%), septic shock occurred in 121,543 cases (41.99%), cardiogenic shock occurred in 44,597 cases (15.41), and obstructive shock occurred in 3,168 cases (1.09%). Of these, 8,147 cases (2.81%) had mixed shock, which means had two or more types of shock. For all the shock cases, the top three frequent concomitant diseases recorded were circulatory system diseases (55.22%), digestive system diseases (53.64%), and respiratory system diseases (53.31%). Of the four types of shock, cases with cardiogenic shock had the highest in-hospital mortality (31.6%), followed by those with obstructive shock (25.2%), septic shock (22.9%), and hypovolemic shock (15.5%). Interestingly, the combination of shock and malignant tumors is one of the major factors that related to hospital deaths.

Conclusions: Shock is a serious disease with a high fatality rate and huge clinical costs. According to this epidemiological survey of shock in China 2018, we should clarify the factors related to the hospital death in shock cases.

Keywords: Hospital Quality Monitoring System (HQMS); Shock; epidemiology; outcome; risk factor.

Figure 1

The flowchart of the patients involved in this study.

Figure 2

Diagnosis rate of various diagnoses in the shock patients. DCS, diseases of the circulatory system; DDS, diseases of the digestive system; DRS, diseases of the respiratory system; ENMD, endocrine, nutritional and metabolic diseases; DBDIM, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; SSACL, symptoms, signs and abnormal clinical and laboratory; DGS, diseases of the genitourinary system; IPD, infectious and parasitic disease; IPEC, injury, poisoning and certain other consequences of external causes; FIHSCHS, Factors influencing health status and contact with health services; PCP, pregnancy, childbirth and the puerperium; DNS, diseases of the nervous system; DMSCT, diseases of the musculoskeletal system and connective tissue; DGS, diseases of the genitourinary system; COPP, certain conditions originating in the perinatal period.

Figure 3

Diagnostic mortality in patients with shock. SSACL, symptoms, signs and abnormal clinical and laboratory; DNS, diseases of the nervous system; DCS, diseases of the circulatory system; DRS, diseases of the respiratory system; ENMD, endocrine, nutritional and metabolic diseases; DGS, diseases of the genitourinary system; IPD, infectious and parasitic disease; DMSCT, diseases of the musculoskeletal system and connective tissue; FIHSCHS, Factors influencing health status and contact with health services; DBDIM, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; DDS, diseases of the digestive system; IPEC, injury, poisoning and certain other consequences of external causes; COPP, certain conditions originating in the perinatal period; PCP, pregnancy, childbirth and the puerperium.