Tiffany Laura Marie, Tran Quincy K, Abdel-Wahab Maie, Widjaja Austin, Aligabi Aya, Albelo Fernando, Asunción Samantha, Gelmann Dominique, Haase Daniel J, Henry Sharon, Leibner Evan, Sjeklocha Lucas
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
J Emerg Trauma Shock. 2022 Jul-Sep;15(3):128-134. doi: 10.4103/jets.jets_38_22. Epub 2022 Sep 28.
Patients who develop occult septic shock (OSS) are associated with worse outcomes than those with early septic shock (ESS). Patients with skin and soft tissue infection (SSTI) may have underlying organ dysfunction due to OSS, yet the prevalence and the outcomes of patients with SSTI and early versus occult shock have not been described. This study compared the clinical characteristics of SSTI patients and the prevalence of having no septic shock (NSS), ESS, or OSS.
We retrospectively analyzed charts of adult patients who were transferred from any emergency department to our academic center between January 1, 2014, and December 31, 2016. Outcomes of interest were the development of OSS and acute kidney injury (AKI). We performed logistic regressions to measure the association between clinical factors with the outcomes and created probability plots to show the relationship between key clinical variables and outcomes of OSS or AKI.
Among 269 patients, 218 (81%) patients had NSS, 16 (6%) patients had ESS, and 35 (13%) patients had OSS. Patients with OSS had higher mean serum lactate concentrations than patients with NSS (3.5 vs. 2.1 mmol/L, < 0.01). Higher sequential organ failure assessment (SOFA) score was associated with higher likelihood of developing OSS (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.23-1.62, < 0.001). NSS was associated with very low odds of developing AKI (OR 0.16, 95% CI 0.08-0.33, < 0.001).
13% of the patients with SSTI developed OSS. Patients with OSS had elevated serum lactate concentration and higher SOFA score than those with NSS. Increased SOFA score is a predictor for the development of OSS.
发生隐匿性感染性休克（OSS）的患者比早期感染性休克（ESS）患者的预后更差。皮肤和软组织感染（SSTI）患者可能因OSS而存在潜在器官功能障碍，但SSTI患者以及早期与隐匿性休克患者的患病率和预后尚未见描述。本研究比较了SSTI患者的临床特征以及无感染性休克（NSS）、ESS或OSS的患病率。
我们回顾性分析了2014年1月1日至2016年12月31日期间从任何急诊科转入我们学术中心的成年患者的病历。感兴趣的结局是OSS和急性肾损伤（AKI）的发生情况。我们进行了逻辑回归分析以衡量临床因素与结局之间的关联，并绘制概率图以显示关键临床变量与OSS或AKI结局之间的关系。
在269例患者中，218例（81%）为NSS，16例（6%）为ESS，35例（13%）为OSS。OSS患者的平均血清乳酸浓度高于NSS患者（3.5 vs. 2.1 mmol/L，P<0.01）。较高的序贯器官衰竭评估（SOFA）评分与发生OSS的可能性较高相关（优势比[OR] 1.41，95%置信区间[CI] 1.23 - 1.62，P<0.001）。NSS与发生AKI的可能性非常低相关（OR 0.16，95%CI 0.08 - 0.33，P<0.001）。
13%的SSTI患者发生了OSS。与NSS患者相比，OSS患者的血清乳酸浓度升高且SOFA评分更高。SOFA评分升高是OSS发生的预测指标。
