Micek Scott T, Isakow Warren, Shannon William, Kollef Marin H
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
Pharmacotherapy. 2005 Jan;25(1):26-34. doi: 10.1592/phco.25.1.26.55615.
To identify predictors of hospital mortality among patients with severe sepsis who were treated with drotrecogin alfa (activated).
Prospective observational cohort study.
A 1400-bed academic medical center.
One hundred two patients treated with drotrecogin alfa (activated) for severe sepsis.
To identify potential risk factors for hospital mortality, the main outcome evaluated, all patients who received drotrecogin alfa (activated) were segregated according to hospital survival. The following characteristics were recorded: age, sex, weight, surgical or nonsurgical, Acute Physiology and Chronic Health Evaluation (APACHE) II score, number of acquired organ-system derangements, mechanical ventilation, use of vasopressors or dobutamine, patient location 24 hours before receiving drotrecogin alfa (activated), source of infection, microbiologically positive culture, and other process-of-care variables. Of the 102 patients, 43 (42.2%) died during their hospitalization. Potential predictors of hospital mortality identified by univariate analysis included greater APACHE II scores, administration of vasopressin or dobutamine, number of acquired organ-system derangements, time to treatment with drotrecogin alfa (activated), intravenous fluid administered before receiving vasopressors or drotrecogin alfa (activated), number of red blood cell transfusions, and administration of inappropriate initial antimicrobial treatment. Multivariate analysis revealed that vasopressin administration (odds ratio [OR] 3.72, 95% confidence interval [CI] 1.95-7.10), number of acquired organ-system derangements (OR 2.30, 95% CI 1.59-3.31), and administration of inappropriate initial antimicrobial treatment (OR 15.5, 95% CI 6.78-35.6) were independently associated with hospital mortality.
Number of acquired organ-system derangements, vasopressin administration, and treatment with an inappropriate initial antimicrobial regimen are independently associated with an increased risk of hospital mortality among patients treated with drotrecogin alfa (activated) for severe sepsis. These findings suggest that other specific medical interventions may increase survival in this patient population.
确定接受活化蛋白C治疗的严重脓毒症患者的医院死亡率预测因素。
前瞻性观察性队列研究。
一家拥有1400张床位的学术医疗中心。
102例接受活化蛋白C治疗严重脓毒症的患者。
为确定医院死亡率的潜在危险因素，即所评估的主要结局，所有接受活化蛋白C治疗的患者按住院存活情况进行分类。记录了以下特征：年龄、性别、体重、手术或非手术情况、急性生理与慢性健康状况评估（APACHE）II评分、获得性器官系统功能紊乱的数量、机械通气、血管升压药或多巴酚丁胺的使用、接受活化蛋白C治疗前24小时的患者所在位置、感染源、微生物学阳性培养结果以及其他治疗过程变量。102例患者中，43例（42.2%）在住院期间死亡。单因素分析确定的医院死亡率潜在预测因素包括更高的APACHE II评分、血管升压素或多巴酚丁胺的使用、获得性器官系统功能紊乱的数量、接受活化蛋白C治疗的时间、在接受血管升压药或活化蛋白C治疗前输注的静脉液体量、红细胞输注次数以及不恰当的初始抗菌治疗。多因素分析显示，血管升压素的使用（比值比[OR] 3.72，95%置信区间[CI] 1.95 - 7.10）、获得性器官系统功能紊乱的数量（OR 2.30，95% CI 1.59 - 3.31）以及不恰当的初始抗菌治疗（OR 15.5，95% CI 6.78 - 35.6）与医院死亡率独立相关。
获得性器官系统功能紊乱的数量、血管升压素的使用以及不恰当的初始抗菌治疗方案与接受活化蛋白C治疗严重脓毒症患者的医院死亡风险增加独立相关。这些发现提示其他特定的医学干预措施可能提高该患者群体的生存率。
