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早期血红蛋白状态作为重症监护病房脓毒症患者长期死亡率的预测指标

Early Hemoglobin Status as a Predictor of Long-Term Mortality for Sepsis Patients in Intensive Care Units.

作者信息

Qi Desheng, Peng Milin

机构信息

Emergency Department, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.

Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.

出版信息

Shock. 2021 Feb 1;55(2):215-223. doi: 10.1097/SHK.0000000000001612.

Abstract

OBJECTIVES

It is still not clear what influences hemoglobin has on the outcomes of patients with sepsis. The intention of this research is to investigate the impact of early hemoglobin levels on clinical outcomes for sepsis.

METHODS

In this single-center, cohort study, each patient was put into one of four groups dependent on hemoglobin levels of 70 g/L, 80 g/L, or 90 g/L in the first 48 h of being admitted to intensive care unit (ICU). Adjustments for baseline/confounding factors were made using the multiple Cox regression model.

RESULTS

In all, 235 septic patients were examined in this research. The non-survivors exhibited significantly higher levels for early hemoglobin status at or below 80 g/L (33.7% vs. 19.4%, P = 0.016) than survivors. Survival curve demonstrated that septic patients with early hemoglobin levels at or below 80 g/L survived at significantly lower rates than those with hemoglobin above 80 g/L. Multivariate Cox analysis demonstrated that levels of 1-year mortality rose as early hemoglobin levels fell in the first 48 h after ICU admission, with relative risks for 80 g/L to 90 g/L, 70 g/L to 80 g/L, and at or below 70 g/L being respectively 1.11 (95% CI: 0.654-1.882), 1.742 (95% CI: 0.969-3.133), 1.981 (95% CI: 1.124-3.492) times higher than those for hemoglobin levels above 90 g/L.

CONCLUSIONS

Hemoglobin levels at or below 80 g/L in the first 48 h after ICU admission are an alternative indicator for predicting long-term mortality of sepsis. Awareness should be encouraged of the importance of targeting early hemoglobin levels when treating sepsis to improve prognosis.

摘要

目的

血红蛋白对脓毒症患者的预后有何影响仍不明确。本研究旨在探讨早期血红蛋白水平对脓毒症临床结局的影响。

方法

在这项单中心队列研究中,根据患者入住重症监护病房(ICU)后48小时内血红蛋白水平为70 g/L、80 g/L或90 g/L,将每位患者分为四组之一。使用多因素Cox回归模型对基线/混杂因素进行调整。

结果

本研究共纳入235例脓毒症患者。非幸存者早期血红蛋白水平在80 g/L及以下的比例(33.7% vs. 19.4%,P = 0.016)显著高于幸存者。生存曲线显示,早期血红蛋白水平在80 g/L及以下的脓毒症患者生存率显著低于血红蛋白水平高于80 g/L的患者。多因素Cox分析表明,ICU入院后48小时内早期血红蛋白水平越低,1年死亡率越高,血红蛋白水平为80 g/L至90 g/L、70 g/L至80 g/L以及70 g/L及以下的相对风险分别是血红蛋白水平高于90 g/L者的1.11倍(95%CI:0.654 - 1.882)、1.742倍(95%CI:0.969 - 3.133)、1.981倍(95%CI:1.124 - 3.492)。

结论

ICU入院后48小时内血红蛋白水平在80 g/L及以下是预测脓毒症长期死亡率的一个替代指标。应鼓励认识到在治疗脓毒症时针对早期血红蛋白水平的重要性,以改善预后。

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