Abou Dagher Gilbert, Harmouche Elie, Jabbour Elsy, Bachir Rana, Zebian Dina, Bou Chebl Ralphe
Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
BMC Emerg Med. 2015 Oct 14;15:30. doi: 10.1186/s12873-015-0057-y.
Bacterial infections are very common in End Stage Renal Disease (ESRD) patients. The diagnosis of sepsis in such patients is often challenging and requires a high index of suspicion. The aim of this study is to report on a series of patient with ESRD on hemodialysis (HD) diagnosed with sepsis.
Single center retrospective study looking at ESRD on HD who presented to our tertiary hospital were retrieved. Inclusion criteria included a discharge diagnosis of sepsis, septic shock or bacteremia.
Our sample was composed of 41 females and 49 males, with a mean age of 70 ± 15 years. Infections from the HD catheters followed by lower respiratory tract infections were the most common cause of bacteremia. IV fluid replacement for the first 6 and 24 h were 0.58 and 1.27 l respectively. Vasopressors were used in 30 patients with norepinephrine, dopamine and dobutamine used in 22, nine and one patients respectively. Out of 90 subjects, 24 (26.6 %) were dead within the same hospital visit. the 28 days out of hospital mortality was 25.6 %. There was no significant difference in mortality in patients who presented with less than two SIRS or two or more SIRS criteria.
This is the first study looking at an in depth analysis of sepsis in the specific dialysis population and examining the influence of fluid resuscitation, role of SIRS criteria and vasopressor use on their mortality.
细菌感染在终末期肾病（ESRD）患者中非常常见。对此类患者败血症的诊断往往具有挑战性，需要高度的怀疑指数。本研究的目的是报告一系列接受血液透析（HD）的ESRD患者被诊断为败血症的情况。
对在我们三级医院就诊的接受HD的ESRD患者进行单中心回顾性研究。纳入标准包括败血症、感染性休克或菌血症的出院诊断。
我们的样本包括41名女性和49名男性，平均年龄为70±15岁。血液透析导管感染继以下呼吸道感染是菌血症最常见的原因。最初6小时和24小时的静脉补液量分别为0.58升和1.27升。30名患者使用了血管升压药，其中22名、9名和1名患者分别使用了去甲肾上腺素、多巴胺和多巴酚丁胺。在90名受试者中，24名（26.6%）在同一次住院期间死亡。出院28天的死亡率为25.6%。出现少于两条全身炎症反应综合征（SIRS）标准或两条或更多SIRS标准的患者在死亡率上没有显著差异。
这是第一项深入分析特定透析人群败血症情况，并研究液体复苏、SIRS标准的作用以及血管升压药的使用对其死亡率影响的研究。
