Ylipalosaari Pekka, Ala-Kokko Tero I, Laurila Jouko, Ohtonen Pasi, Syrjälä Hannu
Department of Infection Control, Oulu University Hospital, FIN-90029 OYS, Finland.
Crit Care. 2006;10(2):R66. doi: 10.1186/cc4902.
The aim of this study was to elucidate the impact of intensive care unit (ICU)-acquired infection on hospital mortality.
Patients with a longer than 48 hour stay in a mixed 10 bed ICU in a tertiary-level teaching hospital were prospectively enrolled between May 2002 and June 2003. Risk factors for hospital mortality were analyzed with a logistic regression model.
Of 335 patients, 80 developed ICU-acquired infection. Among the patients with ICU-acquired infections, hospital mortality was always higher, regardless of whether or not the patients had had infection on admission (infection on admission group (IAG), 35.6% versus 17%, p = 0.008; and no-IAG, 25.7% versus 6.1%, p = 0.023). In IAG (n = 251), hospital stay was also longer in the presence of ICU-acquired infection (median 31 versus 16 days, p < 0.001), whereas in no-IAG (n = 84), hospital stay was almost identical with and without the presence of ICU-acquired infection (18 versus 17 days). In univariate analysis, the significant risk factors for hospital mortality were: Acute Physiology and Chronic Health Evaluation (APACHE) II score >20, sequential organ failure assessment (SOFA) score >8, ICU-acquired infection, age > or = 65, community-acquired pneumonia, malignancy or immunosuppressive medication, and ICU length of stay >5 days. In multivariate logistic regression analysis, ICU-acquired infection remained an independent risk factor for hospital mortality after adjustment for APACHE II score and age (odds ratio (OR) 4.0 (95% confidence interval (CI): 2.0-7.9)) and SOFA score and age (OR 2.7 (95% CI: 2.9-7.6)).
ICU-acquired infection was an independent risk factor for hospital mortality even after adjustment for the APACHE II or SOFA scores and age.
本研究旨在阐明重症监护病房（ICU）获得性感染对医院死亡率的影响。
2002年5月至2003年6月期间，前瞻性纳入了在一家三级教学医院的10张床位混合ICU中住院超过48小时的患者。采用逻辑回归模型分析医院死亡率的危险因素。
335例患者中，80例发生了ICU获得性感染。在发生ICU获得性感染患者中，无论患者入院时是否已有感染（入院时感染组（IAG），35.6%对17%，p = 0.008；非IAG组，25.7%对6.1%，p = 0.023），医院死亡率始终较高。在IAG组（n = 251）中，存在ICU获得性感染时住院时间也更长（中位数31天对16天，p < 0.001），而在非IAG组（n = 84）中，有无ICU获得性感染时住院时间几乎相同（18天对17天）。单因素分析中，医院死亡率的显著危险因素为：急性生理与慢性健康状况评价（APACHE）II评分>20、序贯器官衰竭评估（SOFA）评分>8、ICU获得性感染、年龄≥65岁、社区获得性肺炎、恶性肿瘤或免疫抑制药物治疗以及ICU住院时间>5天。多因素逻辑回归分析中，在调整APACHE II评分和年龄后（比值比（OR）4.0（95%置信区间（CI）：2.0 - 7.9））以及调整SOFA评分和年龄后（OR 2.7（95%CI：2.9 - 7.6）），ICU获得性感染仍是医院死亡率的独立危险因素。
即使在调整APACHE II或SOFA评分及年龄后，ICU获得性感染仍是医院死亡率的独立危险因素。
