Caraballo César, Ascuntar Johana, Hincapié Carolina, Restrepo Camilo, Bernal Elisa, Jaimes Fabián
Grupo Académico de Epidemiología Clínica, Universidad de Antioquia - Medellín, Colombia.
Center for Outcomes Research and Evaluation, Yale University School of Medicine - New Haven, CT, USA.
Rev Bras Ter Intensiva. 2019 Jan-Mar;31(1):47-56. doi: 10.5935/0103-507X.20190011.
To determine the association between the primary site of infection and in-hospital mortality as the main outcome, or the need for admission to the intensive care unit as a secondary outcome, in patients with sepsis admitted to the emergency department.
This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years with a diagnosis of severe sepsis or septic shock who were admitted to the emergency departments of three tertiary care hospitals. Of the 5022 eligible participants, 2510 were included. Multiple logistic regression analysis was performed for mortality.
The most common site of infection was the urinary tract, present in 27.8% of the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%). In 5.4% of the cases, no definite site of infection was identified on admission. Logistic regression revealed a significant association between the following sites of infection and in-hospital mortality when using the urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2; p < 0.001), skin and soft tissues (OR 2.6; 95%CI, 1.4 - 5.0; p = 0.003), bloodstream (OR 2.0; 95%CI, 1.1 - 3.6; p = 0.018), without specific focus (OR 2.0; 95%CI, 1.1 - 3.8; p = 0.028), and intra-abdominal focus (OR 1.9; 95%CI, 1.1 - 3.3; p = 0.024).
There is a significant association between the different sites of infection and in-hospital mortality or the need for admission to an intensive care unit in patients with sepsis or septic shock. Urinary tract infection shows the lowest risk, which should be considered in prognostic models of these conditions.
确定急诊科收治的脓毒症患者感染的主要部位与作为主要结局的院内死亡率之间的关联，以及与作为次要结局的入住重症监护病房需求之间的关联。
这是一项对多中心前瞻性队列研究的二次分析。纳入研究的患者年龄大于18岁，诊断为严重脓毒症或脓毒性休克，被收治于三家三级医疗机构的急诊科。在5022名符合条件的参与者中，2510名被纳入。对死亡率进行了多重逻辑回归分析。
最常见的感染部位是泌尿系统，占病例的27.8%，其次是肺炎（27.5%）和腹腔内病灶（10.8%）。在5.4%的病例中，入院时未确定明确的感染部位。逻辑回归显示，以泌尿系统感染组作为参照时，以下感染部位与院内死亡率之间存在显著关联：肺炎（比值比3.4；95%置信区间，2.2 - 5.2；p < 0.001）、皮肤和软组织（比值比2.6；95%置信区间，1.4 - 5.0；p = 0.003）、血流（比值比2.0；95%置信区间，1.1 - 3.6；p = 0.018）、无特定病灶（比值比2.0；95%置信区间，1.1 - 3.8；p = 0.028）以及腹腔内病灶（比值比1.9；95%置信区间，1.1 - 3.3；p = 0.024）。
脓毒症或脓毒性休克患者不同的感染部位与院内死亡率或入住重症监护病房的需求之间存在显著关联。泌尿系统感染显示出最低风险，在这些病症的预后模型中应予以考虑。
