Hesselink Lillian, Hoepelman Ruben J, Spijkerman Roy, de Groot Mark C H, van Wessem Karlijn J P, Koenderman Leo, Leenen Luke P H, Hietbrink Falco
Department of Trauma Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
Center for Translational Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
J Clin Med. 2020 Jan 10;9(1):191. doi: 10.3390/jcm9010191.
Nowadays, more trauma patients develop chronic critical illness (CCI), a state characterized by prolonged intensive care. Some of these CCI patients have disproportional difficulties to recover and suffer from recurrent infections, a syndrome described as the persistent inflammation, immunosuppression and catabolism syndrome (PICS). A total of 78 trauma patients with an ICU stay of ≥14 days (CCI patients) between 2007 and 2017 were retrospectively included. Within this group, PICS patients were identified through two ways: (1) their clinical course (≥3 infectious complications) and (2) by laboratory markers suggested in the literature (C-reactive protein (CRP) and lymphocytes), both in combination with evidence of increased catabolism. The incidence of PICS was 4.7 per 1000 multitrauma patients. The sensitivity and specificity of the laboratory markers was 44% and 73%, respectively. PICS patients had a longer hospital stay (median 83 vs. 40, < 0.001) and required significantly more surgical interventions (median 13 vs. 3, = 0.003) than other CCI patients. Thirteen PICS patients developed sepsis (72%) and 12 (67%) were readmitted at least once due to an infection. In conclusion, patients who develop PICS experience recurrent infectious complications that lead to prolonged hospitalization, many surgical procedures and frequent readmissions. Therefore, PICS forms a substantial burden on the patient and the hospital, despite its low incidence.
如今，越来越多的创伤患者发展为慢性危重病（CCI），这是一种以长时间重症监护为特征的状态。其中一些CCI患者恢复困难且反复感染，这种综合征被称为持续性炎症、免疫抑制和分解代谢综合征（PICS）。回顾性纳入了2007年至2017年间在重症监护病房（ICU）住院≥14天的78例创伤患者（CCI患者）。在该组中，通过两种方式确定PICS患者：（1）其临床病程（≥3次感染并发症）和（2）根据文献中建议的实验室指标（C反应蛋白（CRP）和淋巴细胞），两者均结合分解代谢增加的证据。PICS的发病率为每1000例多发伤患者中有4.7例。实验室指标的敏感性和特异性分别为44%和73%。与其他CCI患者相比，PICS患者的住院时间更长（中位数83天对40天，<0.001），并且需要更多的手术干预（中位数13次对3次，=0.003）。13例PICS患者发生脓毒症（72%），12例（67%）因感染至少再次入院一次。总之，发生PICS的患者经历反复感染并发症，导致住院时间延长、多次手术和频繁再次入院。因此，尽管PICS发病率较低，但它给患者和医院带来了沉重负担。
