摘要
目的本研究对比革兰阳性菌、阴性菌及真菌所致脓毒症的临床特征,重点分析28 d病死率,以揭示不同病原体对预后的影响。方法研究共纳入85例脓毒症患者,分为革兰阳性菌(GPB)、革兰阴性菌(GNB)和真菌三组。通过回顾性分析收集患者的基本临床资料、生命体征、疾病严重程度(SOFA、SAPSⅡ评分)、合并症、以及临床结局(7 d病死率、28 d病死率、住院时间、机械通气时间、ICU住院时间)等。采用Kaplan-Meier生存曲线和logistic回归模型分析不同病原体类型对患者生存情况的影响。结果GPB组的平均体重显著高于GNB组(P=0.02),真菌组的心率显著高于GPB组和GNB组(P<0.05)。真菌组的SOFA和SAPSⅡ评分显著高于GPB和GNB组(P<0.05)。真菌组的7 d病死率(20.0%)、28 d病死率(40.0%)、总住院时间(13.3 d)和机械通气时间(76.1 h)均显著高于GPB和GNB组(P<0.05)。GNB组的总住院时间和ICU住院时间显著高于GPB组(P<0.05)。生存分析显示,真菌感染患者的预后最差(log-rank检验:P<0.05),与GPB和GNB组相比,28 d病死率的风险比(HR)分别为1.815(95%CI,1.569~2.018;P<0.05)和1.721(95%CI,1.488~1.971;P<0.05)。多因素logistic回归分析证实,革兰阳性菌感染和真菌感染是28 d病死率的独立危险因素,风险比分别为1.51(95%C:1.23~1.82)和2.15(95%CI:1.70~2.72,P<0.05)。结论不同病原体脓毒症患者的临床特征及预后显著不同,真菌感染患者病情更重、病死率高且住院时间长,为预后不良关键;GNB感染患者住院时间较长。因此,准确识别病原体对优化脓毒症治疗至关重要。
Objective This study aimed to compare the clinical characteristics of sepsis caused by Gram-positive bacteria(GPB),Gram-negative bacteria(GNB),and fungi,with a focus on analyzing the 28-day mortality rate to reveal the impact of different pathogens on prognosis.Methods A total of 85 sepsis patients were enrolled and divided into three groups based on pathogens:GPB,GNB,and fungi.Basic clinical data,vital signs,disease severity(SOFA,SAPS II scores),comorbidities,and clinical outcomes(7-day mortality,28-day mortality,length of hospital stay,duration of mechanical ventilation,and ICU stay)were collected through retrospective analysis.Kaplan-Meier survival curves and logistic regression models were used to analyze the effects of different pathogen types on patient survival.Results The mean body weight of the GPB group was significantly higher than that of the GNB group(P=0.02),and the heart rate of the fungi group was significantly higher than that of the GPB and GNB groups(P<0.05).The SOFA and SAPS II scores of the fungi group were significantly higher than those of the GPB and GNB groups(P<O.05).The 7-day mortality rate(20.0%),28-day mortality rate(40.0%),total length of hospital stay(13.3 days),and duration of mechanical ventilation(76.1 hours)in the fungi group were significantly higher than those in the GPB and GNB groups(P<0.05).The total length of hospital stay and ICU stay in the GNB group were significantly longer than those in the GPB group(P<0.05).Survival analysis showed that patients with fungal infections had the worst prognosis(log-rank test:P<0.05).Compared with the GPB and GNB groups,the hazard ratios(HRs)for 28-day mortality were 1.815(95%CI,1.569-2.018;P<0.05)and 1.721(95%CI,1.488-1.971;P<0.05),respectively.Multivariate logistic regression analysis confirmed that Gram-positive bacterial infection and fungal infection were independent risk factors for 28-day mortality,with HRs of 1.51(95%CI:1.23-1.82)and 2.15(95%CI:1.70-2.72,P<0.05),respectively,Conclusion Sepsis patients infected with different pathogens exhibit significant differences in clinical characteristics and prognosis.Fungal infections are associated with more severe illness,higher mortality rates,and longer hospital stays,indicating poor prognosis.Patients with GNB infections have longer hospital stays.Therefore,accurate identification of pathogens is crucial for optimizing sepsis treatment.
作者
石庆玲
郭卫东
徐振兴
SHI Qingling;GUO Weidong;XU Zhenxing(Department of Critical Care Medicine,the Fourth Clinical College of Xinxiang Medical College,Xinxiang Central Hospital,Xinxiang 453000,Henan,China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2024年第11期1317-1321,1326,共6页
Journal of Pathogen Biology
基金
河南省医学科技攻关计划(联合共建)项目(No.LHGJ20191327)。
关键词
病原体
脓毒症
临床特征
风险因素
预后
pathogen
sepsis
clinical characteristics
risk factors
prognosis
