摘要
目的探讨肠杆菌科细菌致血流感染(BSI)重症患者的预后影响因素。方法选择2016年10月至2019年10月滨州医学院附属医院重症医学科收治的血培养为肠杆菌科细菌的重症患者。收集患者性别、年龄、是否合并休克、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、初始用药是否敏感,以及降钙素原(PCT)、白细胞计数(WBC)、血小板计数(PLT)、白蛋白(ALB)的基线数值,根据72 h的PCT水平计算72 h降钙素原清除率(72 h PCTc)。比较28 d预后好转组与死亡组患者各临床指标的差异,将单变量分析中差异有统计学意义的因素纳入Logistic回归,进一步分析影响患者预后的因素;并绘制受试者工作特征曲线(ROC),评估影响因素对BSI重症患者预后的预测效能。结果共纳入86例患者,28 d好转54例,死亡32例,28 d病死率为37.2%。好转组与死亡组患者在性别、年龄、初始用药敏感性、PCT和WBC基线水平等方面比较差异均无统计学意义。死亡组合并休克比例、APACHEⅡ评分、SOFA评分均明显高于好转组〔合并休克比例:84.4%(27/32)比46.3%(25/54),APACHEⅡ(分):24.94±7.65比17.02±6.57,SOFA(分):11.00±3.27比6.30±2.65,均P<0.01〕,PLT和ALB基线水平、72 h PCTc显著低于好转组〔PLT(×10^9/L):73.38±49.15比138.69±101.80,ALB(g/L):25.47±5.91比28.59±4.53,72 h PCTc:-44(-170,27)%比63(40,77)%,均P<0.01〕。将上述6项差异有统计学意义的因素纳入Logistic回归分析,结果显示,SOFA评分是导致肠杆菌科细菌致BSI重症患者死亡的危险因素〔优势比(OR)=1.930,P=0.037〕,72 h PCTc、ALB是保护性因素(OR值分别为0.043、0.783,P值分别为0.008、0.047)。ROC曲线分析显示,SOFA评分、72 h PCTc、ALB均可用于预测BSI重症患者的预后,以三者联合的预测价值最大,ROC曲线下面积(AUC)为0.953,95%可信区间(95%CI)为0.909~0.997,敏感度为100%,特异度为79.6%。结论肠杆菌科细菌致BSI重症患者的病死率较高;SOFA评分越高、ALB水平及72 h PCTc越低,患者预后越差,三者联合对患者预后的预测效能最大。
Objective To investigate the prognostic factors of severe patients with bloodstream infection(BSI)caused by Enterobacteriaceae bacteria.Methods Patients suffered from BSI caused by Enterobacteriaceae bacteria admitted to department of critical care medicine of Binzhou Medical University Hospital from October 2016 to October 2019 were enrolled.The information of gender,age,combined shock,acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),sensitivity of initial antibiotics,as well as the baseline of procalcitonin(PCT),white blood cell count(WBC),platelet(PLT),albumin(ALB)were collected.The 72-hour PCT clearance rate(72 h PCTc)was calculated after 72 hours'treatment.According to the clinical outcome after 28 days,the patients were divided into recovery group and death group.The differences of clinical indicators between the two groups were compared,and then the statistical significant variables were further performed by Logistic regression to analyze the factors affecting the prognosis of patients.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive efficacy of the factors in severe BSI.Results A total of 86 patients were enrolled,among whom 54 cases recovered while 32 cases died,and the 28-day mortality was 37.2%.There was no significant difference in gender,age,sensitivity of initial antibiotics,baseline levels of PCT and WBC between two groups.In the death group,the shock incidence,APACHEⅡscore,SOFA score were significantly higher than those in recovery group[shock incidence:84.4%(27/32)vs.46.3%(25/54),APACHEⅡ:24.94±7.65 vs.17.02±6.57,SOFA:11.00±3.27 vs.6.30±2.65,all P<0.01];the PLT and ALB baseline levels,72 h PCTc were significantly lower than those in recovery group[PLT(×109/L):73.38±49.15 vs.138.69±101.80,ALB(g/L):25.47±5.91 vs.28.59±4.53,72 h PCTc:-44(-170,27)%vs.63(40,77)%,all P<0.01].The above 6 variables were included in Logistic regression.The results showed that SOFA score was a risk factor for death in these patients[odds ratio(OR)=1.930,P=0.037],while 72 h PCTc and ALB were protective factors(OR values were 0.043,0.783,P values were 0.008,0.047).The SOFA,72 h PCTc and ALB can be used to predict the prognosis of severe BSI,and the diagnostic value of the combination of three factors was the largest[area under the ROC curve(AUC)=0.953,95%confidence interval(95%CI)was 0.909-0.997],the sensitivity was 100%,and the specificity was 79.6%.Conclusions Severe patients with BSI caused by Enterobacteriaceae bacteria had a high mortality.Higher SOFA score,and lower ALB and 72 h PCTc predicted the adverse outcome.The combination of the three factors has the greatest prognostic efficacy.
作者
逯峰
马德晶
朱委委
孔桂青
王晓芝
Lu Feng;Ma Dejing;Zhu Weiwei;Kong Guiqing;Wang Xiaozhi(Department of Pulmonary and Critical Care Medicine,Binzhou Medical University Hospital,Binzhou 256603,Shandong,China;Department of Imaging,Binzhou Medical University Hospital,Binzhou 256603,Shandong,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第4期454-457,共4页
Chinese Critical Care Medicine
基金
山东省自然科学基金(ZR2019PH049)
山东省医药卫生科技发展计划项目(2018WS549)。
关键词
肠杆菌科
血流感染
降钙素原清除率
重症监护病房
预后
Enterobacteriaceae
Bloodstream infection
Procalcitonin clearance
Intensive care unit
Prognosis
