Sanderson Miriam, Chikhani Marc, Blyth Esme, Wood Sally, Moppett Iain K, McKeever Tricia, Simmonds Mark Jr
School of Medicine, University of Nottingham, UK.
Sheffield Teaching Hosptials NHS Foundation Trust, UK.
J Intensive Care Soc. 2018 Nov;19(4):299-304. doi: 10.1177/1751143718758975. Epub 2018 Feb 19.
Sepsis represents a significant public health burden, costing the NHS £2.5 billion annually, with 35% mortality in 2006. The aim of this exploratory study was to investigate risk factors predictive of 30-day mortality amongst patients with sepsis in Nottingham.
Data were collected prospectively from adult patients with sepsis in Nottingham University Hospitals NHS Trust as part of an on-going quality improvement project between November 2011 and March 2014. Patients admitted to critical care with the diagnosis of sepsis were included in the study. In all, 97 separate variables were investigated for their association with 30-day mortality. Variables included patient demographics, symptoms of systemic inflammatory response syndrome, organ dysfunction or tissue hypoperfusion, locations of early care, source of sepsis and time to interventions.
A total of 455 patients were included in the study. Increased age (adjOR = 1.05 95%CI = 1.03-1.07 < 0.001), thrombocytopenia (adjOR = 3.10 95%CI = 1.23-7.82 = 0.016), hospital-acquired sepsis (adjOR = 3.34 95%CI = 1.78-6.27 < 0.001), increased lactate concentration (adjOR = 1.16 95%CI = 1.06-1.27 p = 0.001), remaining hypotensive after vasopressors (adjOR = 3.89 95%CI = 1.26-11.95 = 0.02) and mottling (adjOR = 3.80 95%CI = 1.06-13.55 = 0.04) increased 30-day mortality odds. Conversely, fever (adjOR = 0.46 95%CI = 0.28-0.75 = 0.002), fluid refractory hypotension (adjOR = 0.29 95%CI = 0.10-0.87 = 0.027) and being diagnosed in surgical wards (adjOR = 0.35 95%CI = 0.15-0.81 = 0.015) were protective. Treatment timeliness were not significant factors.
Several important predictors of 30-day mortality were found by this research. Retrospective analysis of our sepsis data has revealed mortality predictors that appear to be more patient-related than intervention-specific. With this information, care can be improved for those identified most at risk of death.
脓毒症是一项重大的公共卫生负担，英国国家医疗服务体系（NHS）每年为此花费25亿英镑，2006年的死亡率为35%。这项探索性研究的目的是调查诺丁汉脓毒症患者30天死亡率的预测风险因素。
作为2011年11月至2014年3月期间一项正在进行的质量改进项目的一部分，前瞻性收集了诺丁汉大学医院国民保健服务信托基金中成年脓毒症患者的数据。诊断为脓毒症并入住重症监护病房的患者被纳入研究。总共调查了97个独立变量与30天死亡率的关联。变量包括患者人口统计学特征、全身炎症反应综合征症状、器官功能障碍或组织灌注不足、早期护理地点、脓毒症来源和干预时间。
该研究共纳入455例患者。年龄增加（校正比值比[adjOR]=1.05，95%置信区间[CI]=1.03 - 1.07，P<0.001）、血小板减少（adjOR = 3.10，95%CI = 1.23 - 7.82，P = 0.016）、医院获得性脓毒症（adjOR = 3.34，95%CI = 1.78 - 6.27，P<0.001）、乳酸浓度升高（adjOR = 1.16，95%CI = 1.06 - 1.27，P = 0.001）、使用血管加压药后仍低血压（adjOR = 3.89，95%CI = 1.26 - 11.95，P = 0.02）和皮肤斑纹（adjOR = 3.80，95%CI = 1.06 - 13.55，P = 0.04）会增加30天死亡几率。相反，发热（adjOR = 0.46，95%CI = 0.28 - 0.75，P = 0.002）、液体难治性低血压（adjOR = 0.29，95%CI = 0.10 - 0.87，P = 0.027）和在外科病房诊断（adjOR = 0.35，95%CI = 0.15 - 0.81，P = 0.015）具有保护作用。治疗及时性不是显著因素。
本研究发现了几个30天死亡率的重要预测因素。对我们脓毒症数据的回顾性分析揭示了死亡率预测因素，这些因素似乎与患者本身的相关性大于与干预措施的相关性。有了这些信息，可以改善对那些被确定为死亡风险最高人群的护理。
