Afessa B
University Medical Center, University of Florida Health/Science Center, Jacksonville, USA.
Crit Care Med. 1999 Mar;27(3):554-7. doi: 10.1097/00003246-199903000-00035.
To describe the incidence and causes of systemic inflammatory response syndrome (SIRS), to determine the risk factors for its development, and to assess its impact on the outcome of patients hospitalized for gastrointestinal bleeding.
Prospective, observational study.
A 528-bed, university-affiliated, teaching hospital.
The study included 411 adults hospitalized for gastrointestinal bleeding from January 1, 1995, through June 30, 1996.
We obtained the demographic data, selected clinical findings, laboratory values, length of hospital stay, presence and cause of SIRS, presence of organ failure, and in-hospital mortality for each patient. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score was calculated. Univariate and multivariate logistic regression analyses were used to determine differences between groups.
Patients' ages (mean +/- SD) were 55.9 +/- 17.3 yr; 227 (55%) were male; 247 (60%) were African-American. SIRS developed in 112 patients (27%). Sepsis was the cause of SIRS in 63% of patients (70/112). Severe sepsis developed in 20 patients and septic shock in 5 patients. The most common cause of sepsis was pneumonia (19). There were no significant differences in age, gender, race, and the presence of liver disease between patients with and without SIRS. Upper gastrointestinal bleeding (76/211 vs. 36/ 200; p = .0196), intensive care unit admission (73/152 vs. 391259; p < .0001), and higher APACHE II scores (median, 17 vs. 11; p< .0001) were associated with the development of SIRS. The length of hospital stay was longer (median, 9.5 vs. 3 days; p < .0001), and the number of organ failures (median, 1 vs. 0; p < .0001) and in-hospital mortality rates (23 vs. 4%; p < .0001) were higher in patients with SIRS than in those without SIRS.
SIRS occurs in 27% of patients admitted for gastrointestinal bleeding and is associated with a poor prognosis. Intensive care unit admission, upper gastrointestinal bleeding, and high APACHE II scores are risk factors for the development of SIRS in patients hospitalized for gastrointestinal bleeding.
描述全身炎症反应综合征（SIRS）的发生率及病因，确定其发生的危险因素，并评估其对因胃肠道出血住院患者预后的影响。
前瞻性观察性研究。
一家拥有528张床位的大学附属医院教学医院。
研究纳入了1995年1月1日至1996年6月30日期间因胃肠道出血住院的411名成年人。
我们获取了每位患者的人口统计学数据、选定的临床发现、实验室值、住院时间、SIRS的存在及病因、器官功能衰竭的存在情况以及院内死亡率。计算急性生理与慢性健康状况评估II（APACHE II）评分。采用单因素和多因素逻辑回归分析来确定组间差异。
患者年龄（均值±标准差）为55.9±17.3岁；227名（55%）为男性；247名（60%）为非裔美国人。112名患者（27%）发生了SIRS。63%的患者（70/112）SIRS的病因是脓毒症。20名患者发生了严重脓毒症，5名患者发生了感染性休克。脓毒症最常见的病因是肺炎（19例）。发生SIRS和未发生SIRS的患者在年龄、性别、种族及肝病存在情况方面无显著差异。上消化道出血（76/211 vs. 36/200；p = 0.0196）、入住重症监护病房（73/152 vs. 39/259；p < 0.0001）以及较高的APACHE II评分（中位数，17 vs. 11；p < 0.0001）与SIRS的发生相关。SIRS患者的住院时间更长（中位数，9.5天 vs. 3天；p < 0.0001），器官功能衰竭的数量更多（中位数，1个 vs. 0个；p < 0.0001），院内死亡率更高（23% vs. 4%；p < 0.0001）。
因胃肠道出血入院的患者中27%发生SIRS，且与预后不良相关。入住重症监护病房、上消化道出血和较高的APACHE II评分是因胃肠道出血住院患者发生SIRS的危险因素。
