Morpeth S C, Chambers S T, Gallagher K, Frampton C, Pithie A D
Department of Infectious Diseases, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
J Infect. 2006 Jan;52(1):23-9. doi: 10.1016/j.jinf.2005.02.017.
This study aimed to identify features associated with length of hospital stay (LOHS), length of intravenous antibiotic therapy (LIVAT) and six-week outcomes for patients with lower limb cellulitis, and to test the Eron/Passos classification of cellulitis in the New Zealand system.
Eighty-five variables were collected prospectively from a cohort of 51 inpatients admitted to Christchurch hospital. The primary end-point for analysis was LOHS. LIVAT and six-week outcomes were secondary end-points.
On univariate analysis use of diuretics, living alone, cellulitis acuity, a creatinine concentration of >0.1 mmol/l, poor mobility, pulse >90 bpm, age >70 years, oedema extent, chronic oedema, ulceration, neutrophil count >10x10(9)/l, erythema area >1000 cm2 and haemoglobin concentration less than normal were significantly (P= or <0.05) associated with LOHS. A stay of < or =3 days was associated with less oedema, absence of diuretic use and less acute cellulitis. A stay of >7 days was associated with use of diuretics, living alone, age >70 years, more oedema, erythema area >1000 cm2, haemoglobin less than normal, ulceration, creatinine >0.1 mmol/l and poor mobility. The presence of a discharge was associated with LIVAT. Multivariate analysis accounted for 48% of the variance in LOHS and 16% for LIVAT. Use of diuretics, neutrophil count >10x10(9)/l and oedema score were independently associated with LOHS, with oedema score associated with short stay and diuretic use with long stay. The Eron/Passos system was not helpful so a new scoring system was devised which successfully classified patients into length of stay groups.
The clinical features analysed accounted for half of the variance in LOHS. An important reason may be physician discretion. If so, our scoring system based on these results could be used in a clinical pathway to improve patient care. This tool would need to be evaluated prospectively.
本研究旨在确定与下肢蜂窝织炎患者住院时间（LOHS）、静脉抗生素治疗时间（LIVAT）及六周预后相关的特征，并在新西兰系统中检验蜂窝织炎的埃隆/帕索斯分类法。
前瞻性收集了克赖斯特彻奇医院收治的51例住院患者的85个变量。分析的主要终点是LOHS。LIVAT和六周预后为次要终点。
单因素分析显示，使用利尿剂、独居、蜂窝织炎严重程度、肌酐浓度>0.1 mmol/l、行动不便、脉搏>90次/分钟、年龄>70岁、水肿程度、慢性水肿、溃疡、中性粒细胞计数>10×10⁹/l、红斑面积>1000 cm²及血红蛋白浓度低于正常水平与LOHS显著相关（P =或<0.05）。住院时间≤3天与水肿较轻、未使用利尿剂及蜂窝织炎不太严重相关。住院时间>7天与使用利尿剂、独居、年龄>70岁、水肿更严重、红斑面积>1000 cm²、血红蛋白低于正常水平、溃疡、肌酐>0.1 mmol/l及行动不便相关。出院情况与LIVAT相关。多因素分析解释了LOHS变异的48%和LIVAT变异的16%。使用利尿剂、中性粒细胞计数>10×10⁹/l及水肿评分与LOHS独立相关，水肿评分与住院时间短相关，利尿剂使用与住院时间长相关。埃隆/帕索斯系统并无帮助，因此设计了一种新的评分系统，该系统成功地将患者分为不同住院时间组。
所分析的临床特征占LOHS变异的一半。一个重要原因可能是医生的判断。如果是这样，基于这些结果的我们的评分系统可用于临床路径以改善患者护理。该工具需要进行前瞻性评估。
