University of Turku, Department of Anaesthesiology and Intensive Care, Turku, Finland.
Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland.
Shock. 2018 Jul;50(1):38-43. doi: 10.1097/SHK.0000000000001024.
Cardiac arrest is not a common complication of sepsis, although sepsis has been recognized as one condition behind cardiac arrest. Our aim was to evaluate the prevalence of sepsis among patients with inhospital cardiac arrest (IHCA), and to determine if sepsis is associated with inferior outcome after IHCA.
All consecutive emergency team dispatches in Turku University Hospital in 2011 to 2014 (n = 607) were retrospectively reviewed to identify the patients undergoing cardiopulmonary resuscitation (CPR) for IHCA (n = 301). The patient records were reviewed for the criteria of severe sepsis, organ dysfunction, and chronic comorbidities before IHCA. Outcome was followed for 1 year.
The criteria for prearrest severe sepsis were met by 83/301 (28%) of the patients, and 93/301 (31%) had multiorgan dysfunction (3 or more organ systems). The patients with severe sepsis had higher mortality than those without severe sepsis, increasing from 30-day mortalities of 63/83 (76%) and 151/218 (69%), respectively (P = 0.256), to 1-year mortalities of 72/83 (87%) and 164/218 (75%), respectively (P = 0.030). Emergency admission, age, immunosuppression, DM, multiorgan dysfunction, and a nonshockable rhythm were independent predictors of 1-year mortality by multivariate logistic regression analysis. Six out of 83 patients with severe sepsis before IHCA (7%) survived 1 year with good neurological outcome (CPC scale 1).
A high proportion of patients with IHCA have sepsis and multiorgan dysfunction, and their prognosis is worse than the prognosis of patients with IHCA in general.
心跳骤停并非脓毒症的常见并发症，尽管脓毒症已被认为是心跳骤停的一种潜在病因。本研究旨在评估院内心跳骤停（IHCA）患者中脓毒症的发生率，并确定脓毒症是否与 IHCA 后预后不良相关。
回顾性分析 2011 年至 2014 年图尔库大学医院所有连续的急救小组调度（n=607），以确定因 IHCA 行心肺复苏术（CPR）的患者（n=301）。在发生 IHCA 之前，检查患者记录以确定严重脓毒症、器官功能障碍和慢性合并症的标准。随访 1 年以评估结果。
301 例患者中，83 例（28%）符合 IHCA 前严重脓毒症标准，93 例（31%）存在多器官功能障碍（3 个或更多器官系统）。与无严重脓毒症的患者相比，患有严重脓毒症的患者死亡率更高，30 天死亡率分别从 63/83（76%）和 151/218（69%）增加至 1 年死亡率分别为 72/83（87%）和 164/218（75%）（P=0.256）。通过多变量逻辑回归分析，急诊入院、年龄、免疫抑制、DM、多器官功能障碍和非可电击节律是 1 年死亡率的独立预测因素。在 IHCA 前患有严重脓毒症的 83 例患者中，有 6 例（7%）在 1 年后有良好的神经学结局（CPC 评分 1）存活。
相当比例的 IHCA 患者存在脓毒症和多器官功能障碍，其预后比一般 IHCA 患者的预后差。
