Abbott K C, Agodoa L Y
Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
Clin Nephrol. 2001 Aug;56(2):124-31.
Previous studies have identified risk factors for and mortality associated with hospitalized septicemia (septicemia) in patients with end-stage renal disease (ESRD). However, the etiologies of septicemia in this population have not been determined.
327,993 patients in the United States Renal Data System initiated on ESRD therapy between January 1, 1992, and June 30, 1997, who never received renal transplants were analyzed in a retrospective registry study of hospitalized cases of septicemia (ICD9 038.x).
Of the study population, 43,441 (13.2%) had septicemia. In logistic regression analysis, septicemia was associated with female gender, African American race, ESRD due to diabetes and obstruction/chronic pyelonephritis, increased age, and hemodialysis (vs. peritoneal dialysis). Polycystic kidney disease and glomerulonephritis were associated with decreased risk of septicemia. At initiation of dialysis, higher hemoglobin, and lower weight, creatinine, and albumin were associated with septicemia. Among patients with septicemia, the leading specified etiologies were Staphylococcus (34%) and miscellaneous Gram-negative rods (21.7%). Etiologies of septicemia were significantly associated with hemodialysis (Gram-positives and Pneumococcus), female gender (Gram-negatives except Pseudomonas), African American race (Staphylococcus), and diabetes (global). Hemodialysis (vs. peritoneal dialysis) and Staphylococcus as an etiology of septicemia were associated with repeated hospitalizations for septicemia. Septicemia was independently associated with patient mortality, and African Americans and females with septicemia were at disproportionately greater risk of mortality.
This study identifies significant associations between septicemia and female gender, African American race, hemodialysis, and higher hemoglobin. Significant associations between etiologies of septicemia and patient subgroups are also identified.
既往研究已确定终末期肾病（ESRD）患者住院败血症（脓毒症）的危险因素及相关死亡率。然而，该人群中败血症的病因尚未明确。
对1992年1月1日至1997年6月30日期间在美国肾脏数据系统中开始接受ESRD治疗且从未接受过肾移植的327,993例患者进行回顾性登记研究，分析住院败血症病例（国际疾病分类第九版038.x）。
在研究人群中，43,441例（13.2%）患有败血症。逻辑回归分析显示，败血症与女性、非裔美国人种族、糖尿病及梗阻/慢性肾盂肾炎所致的ESRD、年龄增加及血液透析（与腹膜透析相比）相关。多囊肾病和肾小球肾炎与败血症风险降低相关。透析开始时，较高的血红蛋白水平以及较低的体重、肌酐和白蛋白水平与败血症相关。在败血症患者中，主要的明确病因是葡萄球菌（34%）和其他革兰氏阴性杆菌（21.7%）。败血症的病因与血液透析（革兰氏阳性菌和肺炎球菌）、女性（除假单胞菌外的革兰氏阴性菌）、非裔美国人种族（葡萄球菌）和糖尿病（总体）显著相关。血液透析（与腹膜透析相比）以及葡萄球菌作为败血症病因与败血症再次住院相关。败血症与患者死亡率独立相关，非裔美国人和患败血症的女性死亡风险不成比例地更高。
本研究确定了败血症与女性、非裔美国人种族、血液透析及较高血红蛋白之间的显著关联。还确定了败血症病因与患者亚组之间的显著关联。
