Nutrition and Clinical Services Division (NCSD), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
PLoS One. 2021 Sep 20;16(9):e0257596. doi: 10.1371/journal.pone.0257596. eCollection 2021.
To describe factors associated with severe sepsis in diarrheal adults and their outcomes and offender in blood and stool to understand their interplay as clinical features of sepsis and severe diarrhea often overlap.
We used this retrospective chart analysis employing an unmatched case-control design to study critically ill diarrheal adults aged ≥18 years treated in ICU of Dhaka hospital, icddr,b between January 2011 to December 2015. Of 8,863 in-patient diarrheal adults, 350 having severe sepsis were cases and an equal number of randomly selected non-septic patients were the controls. Cases died significantly more (14.9% vs 4.6%, p = <0.001) than controls. 69% of the cases progressed to septic shock. In logistic regression analysis, steroid intake, ileus, acute kidney injury (AKI), metabolic acidosis, and hypocalcemia were significantly associated with severe sepsis in diarrheal adults (all, p<0.05). 12% of cases (40/335) had bacteremia. Streptococcus pneumoniae [9 (22.5%)] was the single most common pathogen and gram-negatives [27 (67.5%)] were prevailing as a group.
Diarrheal adults who had ileus, AKI, metabolic acidosis, hypocalcemia, and also took steroids were found to have an association with severe sepsis. Strikingly, gram-negative were the predominant bacteria among the diarrheal adults having severe sepsis.
描述与腹泻成人严重脓毒症相关的因素及其结局，并从血液和粪便中寻找病原体，以了解它们作为脓毒症和严重腹泻的临床特征的相互作用，因为这些临床特征经常重叠。
我们使用这种回顾性图表分析，采用不匹配的病例对照设计，研究了 2011 年 1 月至 2015 年 12 月在 icddr,b 的达卡医院 ICU 治疗的年龄≥18 岁的危重症腹泻成人。在 8863 例住院腹泻成人中，有 350 例患有严重脓毒症，为病例，随机选择了相同数量的非脓毒症患者作为对照。病例的死亡率显著更高（14.9%比 4.6%，p<0.001）。69%的病例进展为感染性休克。在逻辑回归分析中，皮质类固醇的摄入、肠梗阻、急性肾损伤（AKI）、代谢性酸中毒和低钙血症与腹泻成人的严重脓毒症显著相关（均 p<0.05）。12%的病例（40/335）有菌血症。肺炎链球菌[9（22.5%）]是最常见的单一病原体，革兰氏阴性菌[27（67.5%）]作为一个群体普遍存在。
患有肠梗阻、AKI、代谢性酸中毒、低钙血症和皮质类固醇摄入的腹泻成人与严重脓毒症相关。引人注目的是，革兰氏阴性菌是患有严重脓毒症的腹泻成人的主要病原体。
