School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Crit Care Med. 2010 Oct;38(10):1984-90. doi: 10.1097/CCM.0b013e3181eeda2c.
Vibrio vulnificus infection is uncommon but potentially life-threatening. The aim of this study was to evaluate clinical outcomes and prognostic factors for patients with V. vulnificus infections admitted to an intensive care unit.
Retrospective study.
Multidisciplinary intensive care unit in a 2300-bed teaching hospital.
Eighty-five adult patients (≥ 18 yrs) with V. vulnificus infections who required intensive care were enrolled and reviewed during a 10-yr period.
None.
Thirty-four of the 85 patients died, giving an intensive care unit mortality rate of 40%. The mean Acute Physiology and Chronic Health Evaluation II score on intensive care unit admission was 18.4 (95% confidence interval, 17.1-19.8). The most common underlying disease was hepatic disease (48%) followed by diabetes mellitus (22%). Multivariate analysis showed that risk factors for intensive care unit mortality were the presence of hemorrhagic bullous skin lesions/necrotizing fasciitis (relative risk, 2.4; 95% confidence interval, 1.3-4.5; p = .006), skin/soft tissue infections involving two or more limbs (relative risk, 2.5; 95% confidence interval, 1.1-5.7; p = .025), and higher Acute Physiology and Chronic Health Evaluation II scores on intensive care unit admission (relative risk, 1.2; 95% confidence interval, 1.1-1.3; p = .0001). In contrast, surgical treatment < 24 hrs after arrival was inversely associated with intensive care unit mortality (relative risk, 0.35; 95% confidence interval, 0.15-0.79; p = .012). In addition, the area under the receiver operating characteristic curve for Acute Physiology and Chronic Health Evaluation II for predicting intensive care unit mortality was 0.945 (95% confidence interval, 0.873-0.983; p = .0001). An optimal cutoff Acute Physiology and Chronic Health Evaluation II score of ≥ 20 had a sensitivity of 97% and a specificity of 86% with a 41.4-fold increased risk of fatality (p = .0003).
This study found that V. vulnificus-infected patients with hemorrhagic bullous skin lesions/necrotizing fasciitis, skin/soft tissue infections involving two or more limbs, or higher Acute Physiology and Chronic Health Evaluation II scores have high risks of intensive care unit mortality. However, patients receiving prompt surgical treatments within 24 hrs after admission have better prognoses.
创伤弧菌感染虽然不常见，但可能危及生命。本研究旨在评估入住重症监护病房的创伤弧菌感染患者的临床结局和预后因素。
回顾性研究。
在一家拥有 2300 张床位的教学医院的多学科重症监护病房。
在 10 年期间，共纳入并回顾了 85 名成年（≥ 18 岁）创伤弧菌感染患者，这些患者需要重症监护。
无。
85 名患者中有 34 名死亡，重症监护病房死亡率为 40%。重症监护病房入院时急性生理学和慢性健康评估 II 评分的平均值为 18.4（95%置信区间，17.1-19.8）。最常见的基础疾病是肝脏疾病（48%），其次是糖尿病（22%）。多变量分析显示，重症监护病房死亡率的危险因素是存在出血性大疱性皮肤病变/坏死性筋膜炎（相对风险，2.4；95%置信区间，1.3-4.5；p =.006）、累及两个或更多肢体的皮肤/软组织感染（相对风险，2.5；95%置信区间，1.1-5.7；p =.025）和重症监护病房入院时较高的急性生理学和慢性健康评估 II 评分（相对风险，1.2；95%置信区间，1.1-1.3；p =.0001）。相反，入院后 24 小时内进行手术治疗与重症监护病房死亡率呈负相关（相对风险，0.35；95%置信区间，0.15-0.79；p =.012）。此外，急性生理学和慢性健康评估 II 预测重症监护病房死亡率的受试者工作特征曲线下面积为 0.945（95%置信区间，0.873-0.983；p =.0001）。急性生理学和慢性健康评估 II 评分≥ 20 的最佳截断值具有 97%的敏感性和 86%的特异性，病死率增加 41.4 倍（p =.0003）。
本研究发现，患有出血性大疱性皮肤病变/坏死性筋膜炎、累及两个或更多肢体的皮肤/软组织感染或较高急性生理学和慢性健康评估 II 评分的创伤弧菌感染患者，重症监护病房死亡率风险较高。然而，入院后 24 小时内接受及时手术治疗的患者预后较好。
