Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
Am J Med Sci. 2010 Jul;340(1):64-8. doi: 10.1097/MAJ.0b013e3181e0ef9b.
Infection is a frequent cause of death in patients with systemic lupus erythematous (SLE) admitted to the intensive care unit (ICU). Complicated clinical features of SLE patients may delay or cause inadequate antimicrobial treatment. This study aimed to determine if inadequate antimicrobial treatment is an independent risk factor for mortality in SLE patients in the ICU.
Fifty-eight SLE patients admitted to the ICU were evaluated in a retrospective analysis. Inadequate antimicrobial treatment was defined by patient receiving antibiotics > or =24 hours after the diagnostic criteria for nosocomial infection and/or the identified microorganism did not exhibit in vitro sensitivity to the antibiotics administered in the ICU.
Multivariate logistic regression analysis identified the risk factors. Thirty-three (56.9%) SLE patients died during their ICU stay. The nonsurvivor group (n = 33), exhibited lower platelet count (P = 0.025), prolonged hospital stay before ICU admission (P = 0.015), higher Acute Physiology and Chronic Health Evaluation II score (P = 0.015), and higher prevalence of multiple organ failure (P = 0.044) and inadequate antimicrobial treatment (P = 0.002) compared with the survivor group (n = 25). In multivariate logistic regression analysis, inadequate antimicrobial treatment was the most significant factor for mortality (odds ratio = 12.02, 95% confidence interval = 1.24-116.10, P = 0.032). Patients with prolonged hospitalization prior ICU admission had a mild risk for mortality (odds ratio = 1.06, 95% confidence interval = 1.00-1.12, P = 0.045).
SLE patients in the ICU receiving inadequate antimicrobial treatment or with prior prolonged hospital stay have a higher risk of mortality. Clinical efforts should ensure adequate antimicrobial treatment in SLE patients with prior prolonged hospital stay before ICU admission.
感染是系统性红斑狼疮（SLE）患者入住重症监护病房（ICU）死亡的常见原因。SLE 患者复杂的临床特征可能会延迟或导致抗菌治疗不足。本研究旨在确定 ICU 中 SLE 患者抗菌治疗不足是否是死亡的独立危险因素。
对 58 例入住 ICU 的 SLE 患者进行回顾性分析。抗菌治疗不足定义为患者在诊断为医院获得性感染标准后 24 小时内接受抗生素治疗，和/或所鉴定的微生物对 ICU 中使用的抗生素无体外敏感性。
多变量逻辑回归分析确定了危险因素。33 例（56.9%）SLE 患者在 ICU 期间死亡。与存活组（n=25）相比，非存活组（n=33）血小板计数较低（P=0.025）、ICU 前住院时间较长（P=0.015）、急性生理学和慢性健康评估 II 评分较高（P=0.015）、多器官衰竭发生率较高（P=0.044）和抗菌治疗不足（P=0.002）。多变量逻辑回归分析显示，抗菌治疗不足是导致死亡的最重要因素（比值比=12.02，95%置信区间=1.24-116.10，P=0.032）。ICU 前住院时间延长的患者死亡风险轻度增加（比值比=1.06，95%置信区间=1.00-1.12，P=0.045）。
ICU 中接受抗菌治疗不足或 ICU 前住院时间延长的 SLE 患者死亡风险较高。临床工作应确保 ICU 前住院时间延长的 SLE 患者获得充分的抗菌治疗。
