院前休克指数评估脓毒性休克 28 天死亡率。

Prehospital shock index to assess 28-day mortality for septic shock.

机构信息

Department of Anesthesia & Intensive Care Unit, SAMU, University Paris Descartes, Hôpital Necker - Enfants, Malades, 149 Rue de Sèvres, 75015 Paris, France; Department of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote, School of Medicine, Faculty of Health Sciences, McMaster University. Hamilton, Ontario, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research, Institute Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada.

Paris Fire Brigade, Teaching Military Hospital Bégin, France.

出版信息

Am J Emerg Med. 2020 Jul;38(7):1352-1356. doi: 10.1016/j.ajem.2019.11.004. Epub 2019 Dec 4.

DOI:10.1016/j.ajem.2019.11.004

PMID:31836349

Abstract

CONTEXT

In the prehospital setting, early identification of septic shock (SS) with high risk of mortality aims to initiate early treatments and to decide delivery unit (emergency department (ED) or intensive care unit (ICU)). In this context, there is a need for a prognostic measure of severity and death in order to early detect patients with a higher risk of pejorative evolution. In this study, we describe the association between prehospital shock index (SI) and mortality at day 28 of patients with SS initially cared for in the prehospital setting by a mobile intensive care unit (MICU).

METHODS

Patients with SS cared for by a MICU between January 2016 and May 2019 were retrospectively analyzed. Using propensity score, the association between SI and mortality was assessed by Odd Ratio (OR) with 95 percent confidence interval [95 CI].

RESULTS

One-hundred and fourteen patients among which 78 males (68%) were analysed. The mean age was 71 ± 14 years old. SS was mainly associated with pulmonary (55%), digestive (20%) or urinary (11%) infection. Overall mortality reached 33% (n = 38) at day 28. Median SI [interquartile range] differed between alive and deceased patients: 0.73 [0.61-1.00] vs 0.80 [0.66-1.10], p < 0.001*). After adjusting for confounding factors, the OR of SI > 0.9 was 1.17 [1.03-1.32].

CONCLUSION

In this study, we report an association between prehospital SI and mortality of patients with prehospital SS. A SI > 0.9 is a readily available tool correlated with increased mortality of patients with SS initially cared for in the prehospital setting.

摘要

背景

在院前环境中，早期识别具有高死亡率风险的感染性休克（SS）旨在启动早期治疗，并决定分娩单位（急诊室（ED）或重症监护病房（ICU））。在这种情况下，需要一种严重程度和死亡的预后指标，以便早期发现预后较差风险较高的患者。在这项研究中，我们描述了院前休克指数（SI）与最初由移动重症监护病房（MICU）院前护理的 SS 患者第 28 天死亡率之间的关联。

方法

回顾性分析了 2016 年 1 月至 2019 年 5 月期间由 MICU 护理的 SS 患者。使用倾向评分，通过比值比（OR）及其 95%置信区间[95%CI]评估 SI 与死亡率之间的关联。

结果

分析了 114 名患者，其中 78 名男性（68%）。平均年龄为 71±14 岁。SS 主要与肺部（55%）、消化（20%）或泌尿系统（11%）感染有关。第 28 天的总体死亡率达到 33%（n=38）。存活和死亡患者的中位数 SI[四分位间距]不同：0.73[0.61-1.00]与 0.80[0.66-1.10]，p<0.001*）。在校正混杂因素后，SI>0.9 的 OR 为 1.17[1.03-1.32]。