Prachanukool Thidathit, Tangkulpanich Panvilai, Paosaree Possawee, Sawanyawisuth Kittisak, Sitthichanbuncha Yuwares
Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand Email :
Asian Pac J Cancer Prev. 2016;17(7):3423-6.
Sepsis is an emergency condition with high mortality and morbidity rate. There are limited data on the association of cancer as a risk factor for mortality in sepsis patients in the emergency department (ED).
This retrospective study was conducted at the ED, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand. The study period was between January 1st and December 31st, 2014. The inclusion criteria were as follows: adult patients over 15 years of age who presented at the ED with suspicion of sepsis, received treatment at the ED, and whose blood culture was found to be positive. Clinical data were recorded from medical records including the Mortality in Emergency Department Sepsis score (MEDS score). The primary outcome of this study was mortality at one month. Multivariate logistic regression analysis was used to identify independent factors associated with death.
During the study period, there were 775 eligible patients. The two most common pathogens identified from blood cultures were Staphylococcus aureus (193 patients; 24.9%) and Escherichia coli (158 patients; 20.4%). At one month after presenting at the ED, 110 patients (14.2%) had died. There were four significant factors for death, having cancer, being on an endotracheal tube, initial diagnosis of bacteremia, and high MED scores. Having cancer had an adjusted OR of 2.12 (95% CI of 1.29, 3.47).
Cancer patients have double the risk of mortality if presenting with sepsis at the ED.
脓毒症是一种死亡率和发病率都很高的紧急病症。关于癌症作为急诊科（ED）脓毒症患者死亡风险因素的关联数据有限。
这项回顾性研究在泰国曼谷拉玛提波迪医院医学院急诊科进行。研究期间为2014年1月1日至12月31日。纳入标准如下：15岁以上成年患者，因疑似脓毒症到急诊科就诊，在急诊科接受治疗，且血培养结果呈阳性。从病历中记录临床数据，包括急诊科脓毒症死亡率评分（MEDS评分）。本研究的主要结局是1个月时的死亡率。采用多因素逻辑回归分析来确定与死亡相关的独立因素。
在研究期间，有775例符合条件的患者。血培养中鉴定出的两种最常见病原体是金黄色葡萄球菌（193例患者；24.9%）和大肠杆菌（158例患者；20.4%）。在急诊科就诊1个月后，110例患者（14.2%）死亡。有四个死亡的显著因素，即患有癌症、使用气管插管、最初诊断为菌血症和MEDS评分高。患有癌症的校正比值比为2.12（95%置信区间为1.29, 3.47）。
癌症患者在急诊科出现脓毒症时死亡风险加倍。
