开发一种临床相关的分类方法以预测重症钩端螺旋体病的死亡率。
Developing a clinically relevant classification to predict mortality in severe leptospirosis.
作者信息
Rajapakse Senaka, Rodrigo Chaturaka, Haniffa Rashan
机构信息
Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
出版信息
J Emerg Trauma Shock. 2010 Jul;3(3):213-9. doi: 10.4103/0974-2700.66519.
BACKGROUND
Severe leptospirosis requires critical care and has a high mortality. We reviewed the literature to identify factors predicting mortality, and such predictors were classified according to the predisposition, infection, response, organ dysfunction (PIRO) concept, which is a risk stratification model used in severe sepsis.
MATERIAL AND METHODS
PUBMED was searched for all articles (English), with the key word leptospirosis in any field, within the last 20 years. Data were collected from 45 relevant papers and grouped into each component of the PIRO model.
RESULTS
THE FOLLOWING CORRELATED WITH INCREASED MORTALITY: predisposition - increasing age and chronic alcoholism; infection - leptospiraemic burden; response - hemodynamic disturbances, leukocytosis; organ dysfunction - multiple organ dysfunction syndrome, pulmonary involvement and acute renal failure.
CONCLUSIONS
Further research is needed to identify the role of infecting serovars, clinical signs, inflammatory markers, cytokines and evidence of hepatic dysfunction as prognostic indicators. It is hoped that this paper will be an initiative to create a staging system for severity of leptospirosis based on the PIRO model with an added component for treatment-related predictors.
背景
重症钩端螺旋体病需要重症监护，且死亡率很高。我们回顾了文献以确定预测死亡率的因素，并根据易感性、感染、反应、器官功能障碍（PIRO）概念对这些预测因素进行分类，PIRO概念是用于严重脓毒症的一种风险分层模型。
材料与方法
在PUBMED中检索过去20年内所有文章（英文），关键词为钩端螺旋体病，不限字段。从45篇相关论文中收集数据，并分组到PIRO模型的各个组成部分。
结果
以下因素与死亡率增加相关：易感性——年龄增长和慢性酒精中毒；感染——钩端螺旋体血症负荷；反应——血流动力学紊乱、白细胞增多；器官功能障碍——多器官功能障碍综合征、肺部受累和急性肾衰竭。
结论
需要进一步研究以确定感染血清型、临床体征、炎症标志物、细胞因子及肝功能障碍证据作为预后指标的作用。希望本文将成为基于PIRO模型创建钩端螺旋体病严重程度分期系统的开端，并增加与治疗相关的预测因素这一组成部分。
Zotero 插件