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发生脓毒症的烧伤患者的预后

Outcomes in Burn-Injured Patients Who Develop Sepsis.

作者信息

Rech Megan A, Mosier Michael J, McConkey Kevin, Zelisko Susan, Netzer Giora, Kovacs Elizabeth J, Afshar Majid

机构信息

Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois.

Department of Emergency Medicine, Loyola University Medical Center.

出版信息

J Burn Care Res. 2019 Apr 26;40(3):269-273. doi: 10.1093/jbcr/irz017.

Abstract

This study examines health outcomes in burn patients with sepsis. We hypothesized that burn patients with sepsis would have an increased odds risk for in-hospital death and longer intensive care unit (ICU) stays. This was a retrospective cohort of consecutive patients admitted to the burn ICU with total BSA (TBSA) ≥10% and/or inhalation injury between January 2008 and March 2015. Overall 407 burn patients were included; the case-rate for sepsis was 39.1% (n = 159); 20.1% (n = 82) patients were septic and 18.9% (n = 77) patients experienced septic shock. Patients with septic shock had the highest mortality rate (13.31% no sepsis vs 3.7% sepsis vs 49.4% septic shock, P < .01). Median 28-day ICU-free days was higher in patients without sepsis (23 days [Interquartile range (IQR) 14-27] no sepsis vs 0 days [IQR 0-10] sepsis vs 0 days [IQR 0-0] septic shock, P < .01). Sepsis (with or without shock) increased odds of in-hospital death (odds ratio 7.04, 95% confidence interval 1.93-25.7) in reference to the no sepsis group. With each incremental Sequential Organ Failure Assessment (SOFA) score or 10% TBSA increase, the odds risk for in-hospital death increased by 56 and 75%, respectively. Our study characterized outcomes in patients with sepsis after severe burn injury. The odds risk for in-hospital death was greater in patients with sepsis, increasing burn severity according to TBSA and SOFA score.

摘要

本研究调查了烧伤合并脓毒症患者的健康结局。我们假设,烧伤合并脓毒症患者的院内死亡风险增加,且在重症监护病房(ICU)的住院时间更长。这是一项回顾性队列研究,纳入了2008年1月至2015年3月期间因烧伤入住ICU且烧伤总面积(TBSA)≥10%和/或有吸入性损伤的连续患者。共纳入407例烧伤患者;脓毒症发病率为39.1%(n = 159);20.1%(n = 82)的患者发生脓毒症,18.9%(n = 77)的患者发生脓毒性休克。脓毒性休克患者的死亡率最高(无脓毒症患者为13.31%,脓毒症患者为3.7%,脓毒性休克患者为49.4%,P <.01)。无脓毒症患者的28天无ICU天数中位数更高(无脓毒症患者为23天[四分位间距(IQR)14 - 27],脓毒症患者为0天[IQR 0 - 10],脓毒性休克患者为0天[IQR 0 - 0],P <.01)。与无脓毒症组相比,脓毒症(无论有无休克)增加了院内死亡几率(比值比7.04,95%置信区间1.93 - 25.7)。随着序贯器官衰竭评估(SOFA)评分每增加1分或TBSA每增加10%,院内死亡几率风险分别增加56%和75%。我们的研究描述了严重烧伤后脓毒症患者的结局。脓毒症患者的院内死亡几率风险更高,且随着TBSA和SOFA评分的增加,烧伤严重程度也增加。

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