危重症患者中的脓毒症、心血管事件和短期死亡风险。

Sepsis, cardiovascular events and short-term mortality risk in critically ill patients.

机构信息

Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore.

出版信息

Ann Acad Med Singap. 2022 May;51(5):272-282. doi: 10.47102/annals-acadmedsg.202220.

DOI:10.47102/annals-acadmedsg.202220

PMID:35658150

Abstract

INTRODUCTION

There is paucity of data on the occurrence of cardiovascular events (CVEs) in critically ill patients with sepsis. We aimed to describe the incidence, risk factors and impact on mortality of CVEs in these patients.

METHODS

This was a retrospective cohort study of critically ill patients admitted to the medical intensive care unit (ICU) between July 2015 and October 2016. The primary outcome was intra-hospital CVEs, while the secondary outcomes were in-hospital mortality, ICU and hospital length of stay.

RESULTS

Patients with sepsis (n=662) had significantly more CVEs compared to those without (52.9% versus 23.0%, <0.001). Among sepsis patients, 350 (52.9%) had 1 or more CVEs: 59 (8.9%) acute coronary syndrome; 198 (29.9%) type 2 myocardial infarction; 124 (18.7%) incident atrial fibrillation; 76 (11.5%) new or worsening heart failure; 32 (4.8%) cerebrovascular accident; and 33 (5.0%) cardiovascular death. Factors associated with an increased risk of CVEs (adjusted relative risk [95% confidence interval]) included age (1.013 [1.007-1.019]); ethnicity-Malay (1.214 [1.005-1.465]) and Indian (1.240 [1.030-1.494]) when compared to Chinese; and comorbidity of ischaemic heart disease (1.317 [1.137-1.527]). There were 278 patients (79.4%) who developed CVEs within the first week of hospitalisation. Sepsis patients with CVEs had a longer median (interquartile range [IQR]) length of stay in the ICU (6 [3-12] vs 4 [2-9] days, <0.001), and hospital (21 [10-42] vs 15 [7-30] days, <0.001) compared to sepsis patients without CVEs. There was no difference in in-hospital mortality between the 2 groups (46.9% vs 45.8%, =0.792).

CONCLUSION

CVEs complicate half of the critically ill patients with sepsis, with 79.4% of patients developing CVEs within the first week of hospitalisation, resulting in longer ICU and hospital length of stay.

摘要

简介

目前有关脓毒症重症患者发生心血管事件（CVE）的数据较少。本研究旨在描述此类患者 CVE 的发生率、危险因素和对死亡率的影响。

方法

这是一项回顾性队列研究，纳入 2015 年 7 月至 2016 年 10 月期间入住内科重症监护病房（ICU）的重症患者。主要结局为院内 CVE，次要结局为院内死亡率、ICU 住院时间和住院时间。

结果

与无 CVE 的患者相比，发生 CVE 的脓毒症患者（52.9% vs. 23.0%，<0.001）明显更多。在脓毒症患者中，有 350 例（52.9%）发生 1 次或多次 CVE：59 例（8.9%）急性冠状动脉综合征；198 例（29.9%）2 型心肌梗死；124 例（18.7%）新发或恶化的心房颤动；76 例（11.5%）新发或加重的心力衰竭；32 例（4.8%）脑血管意外；33 例（5.0%）心血管死亡。与 CVE 风险增加相关的因素（调整后相对风险[95%置信区间]）包括年龄（1.013 [1.007-1.019]）；与中国患者相比，种族-马来人（1.214 [1.005-1.465]）和印度人（1.240 [1.030-1.494]）；合并缺血性心脏病（1.317 [1.137-1.527]）。有 278 例（79.4%）患者在住院的第一周内发生 CVE。发生 CVE 的脓毒症患者 ICU 住院时间（中位数[四分位间距[IQR]）较长[6 [3-12]天比 4 [2-9]天，<0.001]）和医院住院时间（21 [10-42]天比 15 [7-30]天，<0.001]）均长于未发生 CVE 的脓毒症患者。两组间院内死亡率无差异（46.9% vs. 45.8%，=0.792）。