Llitjos Jean-François, Gassama Aïcha, Charpentier Julien, Lambert Jérôme, de Roquetaillade Charles, Cariou Alain, Chiche Jean-Daniel, Mira Jean-Paul, Jamme Matthieu, Pène Frédéric
Service de médecine intensive-réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
Université Paris Descartes, Paris, France.
Ann Intensive Care. 2019 Mar 15;9(1):39. doi: 10.1186/s13613-019-0515-x.
To investigate the determinants and the prognosis of intensive care unit (ICU)-acquired pneumonia in patients with septic shock.
This single-center retrospective study was conducted in a medical ICU in a tertiary care center from January 2008 to December 2016. All consecutive patients diagnosed for septic shock within the first 48 h of ICU admission were included. Patients were classified in three groups: no ICU-acquired infections (no ICU-AI), ICU-acquired pneumonia and non-pulmonary ICU-AI. The determinants of ICU-acquired pneumonia and death were investigated by multivariate competitive risk analysis.
A total of 1021 patients were admitted for septic shock, and 797 patients were alive in the ICU after 48 h of management. The incidence of a first episode of ICU-AI was 31%, distributed into pulmonary (17%) and non-pulmonary ICU-AI (14%). Patients with septic shock caused by pneumonia were at increased risk of further pulmonary ICU-AI with a cumulated incidence of 34.4%. A pulmonary source of the initial septic shock was an independent risk factor for subsequent ICU-acquired pneumonia (cause-specific hazard 2.33, 95% confidence interval [1.55-3.52], p < 0.001). ICU-AI were not associated with a higher risk of ICU mortality after adjustment in a multivariate-adjusted cause-specific proportional hazard model.
Septic shock of pulmonary origin may represent a risk factor for subsequent ICU-acquired pneumonia without affecting mortality.
探讨感染性休克患者重症监护病房（ICU）获得性肺炎的决定因素及预后。
本单中心回顾性研究于2008年1月至2016年12月在一家三级医疗中心的医学ICU进行。纳入所有在ICU入院后48小时内被诊断为感染性休克的连续患者。患者分为三组：无ICU获得性感染（无ICU-AI）、ICU获得性肺炎和非肺部ICU-AI。通过多因素竞争风险分析研究ICU获得性肺炎和死亡的决定因素。
共有1021例患者因感染性休克入院，797例患者在接受治疗48小时后仍存活于ICU。首次发生ICU-AI的发生率为31%，分为肺部（17%）和非肺部ICU-AI（14%）。由肺炎引起的感染性休克患者发生进一步肺部ICU-AI的风险增加，累积发生率为34.4%。初始感染性休克的肺部来源是随后发生ICU获得性肺炎的独立危险因素（病因特异性风险比2.33，95%置信区间[1.55-3.52]，p＜0.001）。在多因素校正的病因特异性比例风险模型中进行校正后，ICU-AI与ICU死亡率升高无关。
肺部来源的感染性休克可能是随后发生ICU获得性肺炎的危险因素，但不影响死亡率。
