外科重症监护病房中的丙型肝炎状况及感染并发症：对1941例连续患者的回顾性分析

Hepatitis C status and infectious complications in the surgical intensive care unit: a retrospective analysis of 1,941 consecutive patients.

作者信息

Kueht Michael, Bebko Serge, Helmick Ryan, Awad Samir

机构信息

Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.

Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Michael E. Debakey VA Medical Center, Department of Surgery/Critical Care, Houston, TX, USA.

出版信息

Am J Surg. 2016 Jun;211(6):1064-70. doi: 10.1016/j.amjsurg.2015.07.033. Epub 2015 Dec 13.

DOI:10.1016/j.amjsurg.2015.07.033

PMID:26746567

Abstract

BACKGROUND

Hepatitis C virus (HCV) infection is thought to be associated with immune dysfunction. We hypothesized that HCV status would be associated with increased infectious complications in the surgical intensive care unit (SICU).

METHODS

All patients admitted to our SICU between 2008 and 2012 were included. We evaluated 90-day mortality and infectious complications in the SICU. Multivariate logistic regression was performed to identify predictors of infectious complications and 90-day mortality.

RESULTS

A total of 1,941 patients were included. The HCV-positive group had a higher overall incidence of infectious complications (25% vs 18%), particularly ventilator-associated pneumonia (VAP) and bacteremia. The increased incidences of VAP and bacteremia persisted when cirrhotic patients were excluded. Prolonged intubation (Odds Ratio [OR] = 2.1), abdominal surgery (OR = 1.6), and model for end-stage liver disease ≥ 15 (OR = 1.4) were independent predictors of SICU infectious complications.

CONCLUSIONS

The HCV-positive group had an increased incidence of infectious complications in the SICU, particularly VAP and bacteremia. This effect persisted when cirrhotic patients were excluded.

摘要

背景

丙型肝炎病毒（HCV）感染被认为与免疫功能障碍有关。我们推测HCV状态与外科重症监护病房（SICU）感染性并发症的增加有关。

方法

纳入2008年至2012年间入住我们SICU的所有患者。我们评估了SICU中90天死亡率和感染性并发症。进行多因素逻辑回归以确定感染性并发症和90天死亡率的预测因素。

结果

共纳入1941例患者。HCV阳性组感染性并发症的总体发生率较高（25%对18%），尤其是呼吸机相关性肺炎（VAP）和菌血症。排除肝硬化患者后，VAP和菌血症的发生率仍持续增加。长时间插管（比值比[OR]=2.1）、腹部手术（OR=1.6）和终末期肝病模型≥15（OR=1.4）是SICU感染性并发症的独立预测因素。