Song Je Eun, Kim Moo Hyun, Jeong Woo Yong, Jung In Young, Oh Dong Hyun, Kim Yong Chan, Kim Eun Jin, Jeong Su Jin, Ku Nam Su, Kim June Myung, Choi Jun Yong
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Infect Chemother. 2016 Sep;48(3):199-208. doi: 10.3947/ic.2016.48.3.199. Epub 2016 Sep 6.
Septic shock remains a leading cause of death, despite advances in critical care management. The Surviving Sepsis Campaign (SSC) has reduced morbidity and mortality. This study evaluated risk factors for mortality in patients with septic shock who received treatment following the SSC bundles.
This retrospective cohort study included patients with septic shock who received treatments following SSC bundles in an urban emergency department between November 2007 and November 2011. Primary and secondary endpoints were all-cause 7- and 28-day mortality.
Among 436 patients, 7- and 28-day mortality rates were 7.11% (31/436) and 14% (61/436), respectively. In multivariate analysis, high lactate level (odds ratio [OR], 1.286; 95% confidence interval [CI], 1.016-1.627; P=0.036) and low estimated glomerular filtration rate (OR, 0.953; 95% CI, 0.913-0.996; P=0.032) were independent risk factors for 7-day mortality. Risk factors for 28-day mortality were high lactate level (OR, 1.346; 95% CI, 1.083-1.673; P=0.008) and high Acute Physiology and Chronic Health Evaluation II score (OR, 1.153; 95% CI, 1.029-1.293; P=0.014).
The risk of mortality of septic shock patients remains high in patients with high lactate levels and acute kidney injury.
尽管重症监护管理取得了进展，但脓毒性休克仍然是主要的死亡原因。拯救脓毒症运动（SSC）降低了发病率和死亡率。本研究评估了接受SSC集束治疗的脓毒性休克患者的死亡风险因素。
这项回顾性队列研究纳入了2007年11月至2011年11月期间在城市急诊科接受SSC集束治疗的脓毒性休克患者。主要和次要终点是全因7天和28天死亡率。
436例患者中，7天和28天死亡率分别为7.11%（31/436）和14%（61/436）。多变量分析显示，高乳酸水平（比值比[OR]，1.286；95%置信区间[CI]，1.016 - 1.627；P = 0.036）和低估计肾小球滤过率（OR，0.953；95%CI，0.913 - 0.996；P = 0.032）是7天死亡率的独立危险因素。28天死亡率的危险因素是高乳酸水平（OR，1.346；95%CI，1.083 - 1.673；P = 0.008）和高急性生理与慢性健康状况评分II（OR，1.153；95%CI，1.029 - 1.293；P = 0.014）。
乳酸水平高和急性肾损伤的脓毒性休克患者的死亡风险仍然很高。
