Luo Xingzheng, Li Lulan, Ou Shuhua, Zeng Zhenhua, Chen Zhongqing
Department of Critical Care Medicine, Affiliated Xiaolan Hospital, Southern Medical University (Xiaolan People's Hospital), Zhongshan, China.
Department of Critical Care Medicine, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Front Med (Lausanne). 2022 Feb 25;9:839284. doi: 10.3389/fmed.2022.839284. eCollection 2022.
To identify the risk factors related to the patient's 28-day mortality, we retrospectively reviewed the records of patients with intra-abdominal infections admitted to the ICU of Nanfang Hospital, Southern Medical University from 2011 to 2018. Multivariate Cox proportional hazard regression analysis was used to identify independent risk factors for mortality. Four hundred and thirty-one patients with intra-abdominal infections were analyzed in the study. The 28-day mortality stepwise increased with greater severity of disease expression: 3.5% in infected patients without sepsis, 7.6% in septic patients, and 30.9% in patients with septic shock ( < 0.001). In multivariate analysis, independent risk factors for 28-day mortality were underlying chronic diseases (adjusted HR 3.137, 95% CI 1.425-6.906), high Sequential Organ Failure Assessment (SOFA) score (adjusted HR 1.285, 95% CI 1.160-1.424), low hematocrit (adjusted HR 1.099, 95% CI 1.042-1.161), and receiving more fluid within 72 h (adjusted HR 1.028, 95% CI 1.015-1.041). Compared to the first and last 4 years, the early use of antibiotics, the optimization of IAT strategies, and the restriction of positive fluid balance were related to the decline in mortality of IAIs in the later period. Therefore, underlying chronic diseases, high SOFA score, low hematocrit, and receiving more fluid within 72 h after ICU admission were independent risk factors for patients' poor prognosis.
为了确定与患者28天死亡率相关的危险因素，我们回顾性分析了2011年至2018年南方医科大学南方医院重症监护病房收治的腹腔内感染患者的病历。采用多因素Cox比例风险回归分析来确定死亡的独立危险因素。本研究共分析了431例腹腔内感染患者。28天死亡率随疾病严重程度的增加而逐步上升：无脓毒症的感染患者为3.5%，脓毒症患者为7.6%，脓毒性休克患者为30.9%（<0.001）。多因素分析显示，28天死亡率的独立危险因素包括基础慢性疾病（校正风险比[HR] 3.137，95%置信区间[CI] 1.425 - 6.906）、高序贯器官衰竭评估（SOFA）评分（校正HR 1.285，95% CI 1.160 - 1.424）、低血细胞比容（校正HR 1.099，95% CI 1.042 - 1.161）以及在72小时内接受更多液体治疗（校正HR 1.028，95% CI 1.015 - 1.041）。与最初4年和最后4年相比，早期使用抗生素、优化抗感染治疗（IAT）策略以及限制正性液体平衡与后期腹腔内感染（IAIs）死亡率的下降有关。因此，基础慢性疾病、高SOFA评分、低血细胞比容以及重症监护病房（ICU）入院后72小时内接受更多液体治疗是患者预后不良的独立危险因素。
