严重脓毒症与脓毒性休克患者预后分析

doi:10.6040/j.issn.1671-7554.0.2015.957

摘要/Abstract

摘要： 目的探讨严重脓毒症与脓毒性休克死亡危险因素,分层分析影响不同生存期患者预后的因素。方法回顾性分析2013年1月至2014年12月108例严重脓毒症与脓毒性休克患者临床资料,通过多因素Cox回归模型明确死亡的独立危险因素。结果总死亡率为53.7%,生存期<30 d,30 d~89 d,90 d~365 d患者死亡率分别为27.8%、24.4%与15.3%。急性生理与慢性健康评分(APACHE-Ⅱ评分)、查尔森合并症指数(CCI)与降钙素原变化率(△PCT)是影响死亡率的独立预后因素,HR(95%CI)分别为1.105(1.066~1.146)、1.390(1.210~1.596)与0.996(0.995~0.997)。分层分析,生存期<30 d者,预后因素为APACHE-Ⅱ评分(HR=1.104, 95%CI:1.052~1.158)、CCI(HR=1.462, 95%CI:1.204~1.775)、△PCT(HR=0.992, 95%CI:0.989~0.995)与ICU住院时间(HR=0.893, 95%CI:0.841~0.949);生存期30 d~89 d者,预后因素为APACHE-Ⅱ评分(HR=1.102, 95%CI:1.026~1.183)与△PCT(HR=0.996, 95%CI:0.994~0.998)。生存期90 d~365 d者,仅CCI(HR=1.689, 95%CI:1.065~2.679)影响预后。结论 APACHE-Ⅱ评分、CCI与△PCT为影响严重脓毒症与脓毒性休克患者死亡率的独立预后因素。但对于不同生存期的死亡患者,其预后因素稍有不同,需进一步开展多中心大样本的前瞻性队列研究证实。

关键词: 严重脓毒症, 脓毒性休克, 分层分析, 预后

Abstract: Objective To explore the prognostic factors for patients with severe sepsis and septic shock according to the survival periods. Methods Clinical data of 108 cases of severe sepsis and septic shock treated during Jan. 2013 and Dec. 2014 were retrospectively studied. The independent risk factors of death was analyzed with Cox porportional hazard models. Results The overall mortality was 53.7%, and the mortality at days 0-29, 30-89, and 90-365 was 27.8%, 24.4% and 15.3%, respectively. Factors significantly associated with mortality included APACHE-Ⅱscore(HR=1.105, 95%CI: 1.066-1.146), Charlson Comorbidities Index(CCI)(HR=1.390, 95%CI: 1.210-1.596)and procalcitonin changes(△PCT)(HR=0.996, 95%CI: 0.995-0.997). Results of stratified analysis according to different survival periods indicated that, APACHE-Ⅱscore(HR=1.104, 95%CI: 1.052-1.158), CCI(HR=1.462, 95%CI: 1.204-1.775), △PCT(HR=0.992, 95%CI: 0.989-0.995), and days of ICU-stay(HR=0.893, 95%CI: 0.841-0.949)were the prognostic factors for patients who survived for less than 30 days; risk factors associated with mortality included APACHE-Ⅱscore(HR=1.102, 95%CI: 1.026-1.183)and △PCT(HR=0.996, 95%CI: 0.994-0.998)for patients who survived for 30 d-89 d; for patients survived for 90 d-365 d, CCI(HR=1.689, 95%CI: 1.065-2.679)was the only prognostic factor. Conclusions APACHE-Ⅱscore, CCI and △PCT are the independent 山东大学学报 (医学版)54卷10期 -刘晓,等.严重脓毒症与脓毒性休克患者预后分析 \=-prognostic factors for patients with severe sepsis and septic shock, while there were slight differences among different survival periods. It is necessary to develop a multicenter large-scale prospective cohort study for further confirmation.

Key words: Stratified analysis, Severe sepsis, Septic shock, Prognosis

中图分类号:

R631

刘晓,刘志广,范志松,王媛,杨兴肖,孔洁羽,陈俊卓,刘俊霞. 严重脓毒症与脓毒性休克患者预后分析[J]. 山东大学学报（医学版）, 2016, 54(10): 80-84.

LIU Xiao, LIU Zhiguang, FAN Zhisong, WANG Yuan, YANG Xingxiao, KONG Jieyu, CHEN Junzhuo, LIU Junxia. Prognostic analysis of patients with severe sepsis and septic shock[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(10): 80-84.

参考文献

[1] Cawcutt KA, Peters SG. Severe sepsis and septic shock: clinical overview and update on management[J]. Mayo Clin Proc, 2014, 89(11): 1572-1578.
[2] Blanco J, Muriel-Bombín A, Sagredo V, et al. Incidence, organ dysfunction and mortality in severe sepsis: A Spanish multicentrestudy[J]. Crit Care, 2008, 12(6): R158.
[3] Rodríquez F, Barrera L, De La Rosa G, et al. The epidemiology of sepsis in Colombia: a prospective multicenter cohort study in ten university hospitals[J]. Crit Care Med, 2011, 39(7): 1675-1682.
[4] 商娜,周荣斌. 脓毒症流行病学研究[J]. 中国急救医学, 2013, 33(1): 8-12. SHANG Na, ZHOU Rongbin. Research on the epidemiology of sepsis[J]. Chin J Crit Care Med, 2013, 33(1): 8-12.
[5] Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012[J]. Intensive Care Med, 2013, 39(2): 165-228.
[6] Baharoon S, Telmesani A, Tamim H, et al. Community-versus nosocomial-acquired severe sepsis and septic shock in patients admitted to a tertiary intensive care in Saudi Arabia, etiology and outcome[J]. J Infect Public Health, 2015, 8(5): 418-424.
[7] Winters BD, Eberlein M, Leung J, et al. Long-term mortality and quality of life in sepsis: a systematic review[J]. Crit Care Med, 2010, 38(5): 1276-1283.
[8] 郑秀芹, 钟晓梅, 马建华, 等. 降钙素原结合APACHE-Ⅱ评分在老年重症感染患者中的诊断和预后意义[J]. 中国感染与化疗杂志, 2015, 15(1): 47-50. ZHENG Xiuqin, ZHONG Xiaomei, MA Jianhua, et al. Diagnostic and prognostic implication of procalcitonin combined with APACHE-Ⅱscore in elderly patients with severe infection[J]. Chin J Infect Chemother, 2015, 15(1): 47-50.
[9] 黄伟平, 江稳强, 胡北, 等. 降钙素原对全身炎症反应综合征患者病情预后的判断价值[J]. 中华危重病急救医学, 2012, 24(5): 294-297. HUANG Weiping, JIANG Wenqiang, HU Bei, et al. Significance of serum procalcitonin levels in the evaluation of severity and prognosis of patients with systemic inflammatory response syndrome[J]. Chin Crit Care Med, 2012, 24(5): 294-297.
[10] Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation[J]. J Chronic Dis, 1987, 40(5): 373-383.
[11] Yang Y, Yang KS, Hsann YM, et al. The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis[J]. J Crit Care, 2010, 25(3): 398-405.
[12] Storgaard M, Hallas J, Gahrn-Hansen B, et al. Short- and long-term mortality in patients with community-acquired severe sepsis and septic shock[J]. Scand J Infect Dis, 2013, 45(8): 577-583.
[13] Lemay AC, Anzueto A, Restrepo MI, et al. Predictors of long-term mortality after severe sepsis in the elderly[J]. Am J Med Sci, 2014, 347(4): 282-288.
[14] 马晓春. 应重视脓毒症的抗凝治疗[J]. 中华危重病急救医学, 2010, 22(9): 516-517.
[15] 中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)[J]. 中华危重病急救医学, 2015, 27(6): 401-426.
[16] 占志刚,李春盛. D-二聚体对急诊脓毒症患者预后价值的前瞻性研究[J]. 中华危重病急救医学,2012, 24(3): 135-138. ZHAN Zhigang, LI Chunsheng. Prognostic value of D-dimer in patients with sepsis in emergency department: a prospective study[J]. Chin Crit Care Med, 2012, 24(3): 135-138.
[17] “D-二聚体检测”急诊临床应用专家共识组. “D-二聚体检测”急诊临床应用专家共识[J]. 中华急诊医学杂志, 2013, 22(8): 827-836.

相关文章 15

[1]	栗英林,宋道庆,徐忠华. 应用生物信息学方法分析肾透明细胞癌中FKBP11的表达[J]. 山东大学学报 (医学版), 2020, 1(9): 45-51.
[2]	史爽,李娟,米琦,王允山,杜鲁涛,王传新. 胃癌miRNAs预后风险评分模型的构建与应用[J]. 山东大学学报 (医学版), 2020, 1(7): 47-52.
[3]	路璐,孙志钢,张楠. 继发性嗜血细胞综合征1例[J]. 山东大学学报 (医学版), 2020, 1(7): 122-124.
[4]	李星凯,刘战业,姜运峰,李军. 原发性中央型和周围型肺鳞癌临床病理学及预后差异[J]. 山东大学学报（医学版）, 2017, 55(9): 73-78.
[5]	宗帅,肖东杰,刘华,郏雁飞,马晓丽,李焕杰,黎娉,郑燕,汪运山. CSN5在胃癌中的表达及与患者预后的相关性[J]. 山东大学学报（医学版）, 2017, 55(7): 12-16.
[6]	孙启晶,陈方方,李春晓,张才擎. PNI及HGB评估中晚期非小细胞肺癌患者预后的临床价值[J]. 山东大学学报（医学版）, 2017, 55(4): 55-59.
[7]	董尧,宋亚林,田涛,高建国. 确诊8年未经治疗却无明显进展的阴茎恶性黑色素瘤1例报道[J]. 山东大学学报（医学版）, 2017, 55(3): 125-126.
[8]	林家香,郭子嘉,苏鹏,王晓,郭雅欣,吴晓娟,相磊,周志强, 王妍,崔秀杰,潘爱凤,郭成浩. 致癌蛋白CIP2A在乳腺导管上皮恶变中的作用及预测浸润性导管癌患者预后的能力[J]. 山东大学学报（医学版）, 2017, 55(3): 100-106.
[9]	周兰兰,潘学谊,郭煜. 48例急性混合细胞表型白血病患者的临床特征及预后[J]. 山东大学学报（医学版）, 2017, 55(2): 79-83.
[10]	张希英,翟春颜,李劲松,韩博. 中国尤文肉瘤患者EZH2蛋白表达与临床病理学参数及预后的关系[J]. 山东大学学报（医学版）, 2017, 55(2): 84-91.
[11]	刘惠苓,王兴文,冯少滨,冯虹,韩俊庆. B类I型清道夫受体的高表达与结肠癌患者预后的相关性[J]. 山东大学学报（医学版）, 2017, 55(10): 84-89.
[12]	李晓宁,崔连群. 急性心肌梗死合并多支血管病变患者非梗死相关动脉处理的时机[J]. 山东大学学报（医学版）, 2016, 54(8): 50-54.
[13]	王雯,刘尧,龙飞,马卫霞,苏莉莉. 外周血淋巴细胞/单核细胞比值与恶性胸膜间皮瘤患者预后的关系[J]. 山东大学学报（医学版）, 2016, 54(8): 72-77.
[14]	刘童,张欣,王传新. IRX5 mRNA在结直肠癌诊断及预后中的价值[J]. 山东大学学报（医学版）, 2016, 54(7): 69-74.
[15]	马琳,张冬,唐蕾,叶嗣源,焉传祝,曹丽丽. 肌萎缩侧索硬化预后相关的血液学标志物[J]. 山东大学学报（医学版）, 2016, 54(4): 46-50.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed