From the Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
J Trauma Acute Care Surg. 2014 Mar;76(3):725-9. doi: 10.1097/TA.0b013e3182aafe6b.
Persistent inflammation-immunosuppression catabolism syndrome (PICS) is a newly proposed concept that has replaced late multiple-organ failure and prolongs surgical intensive care unit (ICU) duration. Enterocutaneous fistula (ECF) is one of the most challenging complications in the practice of surgery. However, no studies have been performed connecting PICS with ECF.
A total of 130 ECF patients admitted to ICU between January 2011 and January 2012 were retrospectively studied. Two residents of our center collected data (including demographics, clinical manifestation, underlying disease, Acute Physiology and Chronic Health Evaluation II score, therapeutic schedules, laboratory test reports, and clinical outcomes) from electronic medical records for each patient. We further investigated the prevalence of PICS in patients with ECF and compared the demographics, disease severity, complications, clinical outcomes, and prognosis between PICS and non-PICS patients.
The overall incidence of PICS in ECF was 43.1%. The mortality rates of non-PICS and PICS groups were 7.1% and 28.3%, respectively. Compared with the non-PICS group, the PICS group showed an increased age, a higher fistula output, but a lower body mass index and albumin level. However, the Acute Physiology and Chronic Health Evaluation II score did not differ between the two groups. During the whole treatment course, the PICS group showed a higher risk of developing pneumonia and catheter-related blood stream infection compared with the non-PICS group. Although the overall incidences of sepsis were similarly, the risk of developing sepsis after the first 7 days of admission was significantly higher in the PICS group (67.9% vs. 38.6%, p = 0.002). Moreover, the PICS group experienced longer stays in the ICU, higher hospital charges, and higher probabilities of mechanical ventilation compared with the non-PICS group.
PICS is a common manifestation of patients with ECF. ECF provides an excellent clinical model to study PICS owing to the pathophysiologic characteristics of ECF itself.
Prognostic study, level III.
持续性炎症-免疫抑制-分解代谢综合征（PICS）是一个新提出的概念，它取代了晚期多器官衰竭，并延长了外科重症监护病房（ICU）的住院时间。肠外瘘（ECF）是外科实践中最具挑战性的并发症之一。然而，目前还没有研究将 PICS 与 ECF 联系起来。
回顾性研究了 2011 年 1 月至 2012 年 1 月期间入住 ICU 的 130 例 ECF 患者。我们中心的两名住院医师从每位患者的电子病历中收集数据（包括人口统计学、临床表现、基础疾病、急性生理学和慢性健康评估 II 评分、治疗方案、实验室检查报告和临床结果）。我们进一步调查了 ECF 患者中 PICS 的患病率，并比较了 PICS 患者和非 PICS 患者的人口统计学、疾病严重程度、并发症、临床结果和预后。
ECF 患者中 PICS 的总发生率为 43.1%。非 PICS 组和 PICS 组的死亡率分别为 7.1%和 28.3%。与非 PICS 组相比，PICS 组患者年龄较大，瘘管流量较高，但体重指数和白蛋白水平较低。然而，两组的急性生理学和慢性健康评估 II 评分无差异。在整个治疗过程中，PICS 组比非 PICS 组发生肺炎和导管相关血流感染的风险更高。虽然败血症的总发生率相似，但 PICS 组在入院后第 7 天发生败血症的风险明显高于非 PICS 组（67.9%比 38.6%，p=0.002）。此外，PICS 组在 ICU 停留时间较长、住院费用较高、机械通气的可能性较大。
PICS 是 ECF 患者的常见表现。ECF 为研究 PICS 提供了一个极好的临床模型，因为 ECF 本身具有病理生理特征。
预后研究，III 级。
