Hill David M, Percy Matthew D, Velamuri Sai R, Lanfranco Julio, Romero Legro Ivan, Sinclair Scott E, Hickerson William L
Department of Pharmacy, Firefighters Burn Center, Regional One Health, Memphis, Tennessee.
Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis.
J Burn Care Res. 2018 Oct 23;39(6):982-988. doi: 10.1093/jbcr/iry022.
Sepsis is the largest cause of mortality in thermally injured patients. Traditional systemic inflammatory response syndrome (SIRS) criteria do not aid diagnosis of sepsis in burn centers. Studies have attempted identification of the best indicators of sepsis in the thermal injured patient, but predictive variables are inconsistent across the various studies. Currently, consensus guidelines lack evidential support as to which patients will benefit most from prompt antimicrobial therapy. The purpose of our study was to evaluate novel diagnostic parameters for thermal injured patients with known sepsis and compare these parameters with existing diagnostic criteria. This study was a retrospective, electronic medical record review. Baseline demographics were analyzed utilizing chi-square, Mann-Whitney U test, or t test. Each patient served as their own control. Generalized linear mixed modeling was utilized for univariable and multivariable analysis. Several models with ≤6 variables each were built with the top performing variables. Performance was analyzed using area under receiver operating curves, sensitivity, specificity, positive predictive value, and negative predictive value. Three hundred and ninety-nine patients were screened. Twenty-nine patients remained after exclusions, leaving 198 blood culture results (62 positive) for analysis. Forty variables were statistically significant during univariable analysis. From multivariable analysis, the best performing model was: Temperature > 39°C or < 36°C, heart rate > 130 beats/min, 10% decrease in mean arterial pressure, and gastric residual volumes twice the feeding rate. Meeting at least one variable of the presented model best identified incidence of sepsis with positive bloodstream infections and outperformed current models in our patients.
脓毒症是热损伤患者死亡的最大原因。传统的全身炎症反应综合征（SIRS）标准无助于烧伤中心对脓毒症的诊断。已有研究试图确定热损伤患者脓毒症的最佳指标，但不同研究中的预测变量并不一致。目前，关于哪些患者将从及时的抗菌治疗中获益最多，共识指南缺乏证据支持。我们研究的目的是评估已知患有脓毒症的热损伤患者的新诊断参数，并将这些参数与现有诊断标准进行比较。本研究是一项回顾性电子病历审查。利用卡方检验、曼-惠特尼U检验或t检验分析基线人口统计学数据。每位患者都作为自身对照。采用广义线性混合模型进行单变量和多变量分析。利用表现最佳的变量构建了几个每个模型变量数≤6个的模型。使用受试者工作特征曲线下面积、灵敏度、特异度、阳性预测值和阴性预测值分析模型性能。共筛查了399例患者。排除后剩下29例患者，留下198份血培养结果（62份阳性）用于分析。单变量分析中有40个变量具有统计学意义。多变量分析中，表现最佳的模型为：体温>39°C或<36°C、心率>130次/分钟、平均动脉压下降10%以及胃残余量是喂养速度的两倍。满足所提出模型的至少一个变量能最好地识别伴有血流感染阳性的脓毒症发生率，且在我们的患者中其表现优于当前模型。
