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内科病房收治的脓毒症患者的临床特征、短期死亡率及预后危险因素:一项意大利多中心前瞻性研究的结果

Clinical Features, Short-Term Mortality, and Prognostic Risk Factors of Septic Patients Admitted to Internal Medicine Units: Results of an Italian Multicenter Prospective Study.

作者信息

Mazzone Antonino, Dentali Francesco, La Regina Micaela, Foglia Emanuela, Gambacorta Maurizia, Garagiola Elisabetta, Bonardi Giorgio, Clerici Pierangelo, Concia Ercole, Colombo Fabrizio, Campanini Mauro

机构信息

From the Internal Medicine Ward, Ospedale Civile, Legnano (AM, GB); Department of Clinical Medicine, Insubria University Varese (FD); Internal Medicine Hospital of La Spezia, La Spezia (MLR); Centre for Research on Health Economics, Social and Health Care Management-CREMS, University Carlo Cattaneo-LIUC, Castellanza (EF, EG); Internal Medicine Ward, Hospital Media Valle del Tevere, Todi (MG, PC); Microbiology Unit, Legnano Hospital, Legnano, Italy (PC), Italy; Infectious Diseases, Policlinico G.B. Rossi, University of Verona (EC); Internal Medicine Ward, Ospedale Niguarda Ca' Granda, Milan (FC); and Internal Medicine Ward, Ospedale Maggiore della Carità, Novara, Italy (MC).

出版信息

Medicine (Baltimore). 2016 Jan;95(4):e2124. doi: 10.1097/MD.0000000000002124.

Abstract

Only a few studies provided data on the clinical history of sepsis within internal Medicine units. The aim of the study was to assess the short-term mortality and to evaluate the prognostic risk factors in a large cohort of septic patients treated in internal medicine units. Thirty-one internal medicine units participated to the study. Within each participating unit, all admitted patients were screened for the presence of sepsis. A total of 533 patients were included; 78 patients (14.6%, 95%CI 11.9, 18.0%) died during hospitalization; mortality rate was 5.5% (95% CI 3.1, 9.6%) in patients with nonsevere sepsis and 20.1% (95%CI 16.2, 28.8%) in patients with severe sepsis or septic shock. Severe sepsis or septic shock (OR 4.41, 95%CI 1.93, 10.05), immune system weakening (OR 2.10, 95%CI 1.12, 3.94), active solid cancer (OR 2.14, 95% CI 1.16, 3.94), and age (OR 1.03 per year, 95% CI 1.01, 1.06) were significantly associated with an increased mortality risk, whereas blood culture positive for Escherichia coli was significantly associated with a reduced mortality risk (OR 0.46, 95%CI 0.24, 0.88). In-hospital mortality of septic patients treated in internal medicine units appeared similar to the mortality rate obtained in recent studies conducted in the ICU setting.

摘要

仅有少数研究提供了内科病房内脓毒症临床病史的数据。本研究的目的是评估一大群在内科病房接受治疗的脓毒症患者的短期死亡率,并评估预后风险因素。31个内科病房参与了该研究。在每个参与的病房中,对所有入院患者进行脓毒症筛查。共纳入533例患者;78例患者(14.6%,95%置信区间11.9,18.0%)在住院期间死亡;非重症脓毒症患者的死亡率为5.5%(95%置信区间3.1,9.6%),重症脓毒症或脓毒性休克患者的死亡率为20.1%(95%置信区间16.2,28.8%)。重症脓毒症或脓毒性休克(比值比4.41,95%置信区间1.93,10.05)、免疫系统减弱(比值比2.10,95%置信区间1.12,3.94)、活动性实体癌(比值比2.14,95%置信区间1.16,3.94)和年龄(每年比值比1.03,95%置信区间1.01,1.06)与死亡风险增加显著相关,而大肠杆菌血培养阳性与死亡风险降低显著相关(比值比0.46,95%置信区间0.24,0.88)。在内科病房接受治疗的脓毒症患者的院内死亡率似乎与近期在重症监护病房环境中进行的研究所获得的死亡率相似。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6812/5291546/92ff615d90e0/medi-95-e2124-g003.jpg

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