脓毒症患者30天生存的院前预后因素；一项回顾性队列研究。
Pre-hospital Prognostic Factors of 30-Day Survival in Sepsis Patients; a Retrospective Cohort Study.
作者信息
Huabbangyang Thongpitak, Klaiangthong Rossakorn, Jaibergban Fahsai, Wanphen Chanathip, Faikhao Thanakorn, Banjongkit Passakorn, Kuchapan Ratchaporn
机构信息
Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand.
Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
出版信息
Arch Acad Emerg Med. 2023 Jul 13;11(1):e48. doi: 10.22037/aaem.v11i1.2029. eCollection 2023.
INTRODUCTION
According to excising findings, if the emergency management system (EMS) operation will be developed, the survival outcome of sepsis patients might improve. This study aimed to evaluate the pre-hospital associated factors of survival in sepsis patients.
METHODS
This retrospective cohort study was conducted on patients diagnosed with sepsis, coded with the Thailand emergency medical triage protocol and criteria-based dispatch symptom group 17. Information on the 30-day survival rate of patients was obtained from the electronic medical records. Pre-hospital factors associated with 30-day survival were analyzed using univariate and multivariate logistic regression analyses and were reported using odds ratio (OR) with 95% confidence interval (CI).
RESULTS
300 patients diagnosed with sepsis were enrolled. Among them, 232 (77.3%) survived within 30 days. Non-survived cases had significantly older age (p = 0.019), lower oxygen saturations (92.5% vs. 95.0%; p = 0.003), higher heart rate (p = 0.001), higher respiratory rate (p < 0.001), lower level of consciousness (p < 0.001), higher disease severity based on qSOFA score (p = 0.001), and higher need for invasive airway management (p = 0.001) and supplementary oxygen (p = 0.001). The survival rate improved by 3.5% with every 1% increase in pre-hospital oxygen saturation (adjusted OR = 1.035, 95% CI: 1.005-1.066, p = 0.020) and the survival probabilities of patients who responded to voice (adjusted OR = 0.170, 95% CI: 0.050-0.579, p = 0.005), those who responded to pain (adjusted OR = 0.130, 95% CI: 0.036-0.475, p = 0.002), and those who were unresponsive (adjusted OR = 0.086, 95% CI: 0.026-0.278, p-value < 0.001) were lower than patients who were alert.
CONCLUSION
The 30-day survival rate of patients with sepsis managed by the EMS team was 77.3%. Pre-hospital oxygen saturation and level of consciousness were associated with the survival of patients with sepsis who were managed in the pre-hospital setting.
引言
根据切除结果，如果能改进应急管理系统（EMS）的运作，脓毒症患者的生存结局可能会得到改善。本研究旨在评估脓毒症患者院前与生存相关的因素。
方法
本回顾性队列研究针对诊断为脓毒症的患者进行，这些患者按照泰国急诊医疗分诊协议和基于标准的调度症状组17进行编码。患者30天生存率的信息从电子病历中获取。使用单因素和多因素逻辑回归分析来分析与30天生存相关的院前因素，并以比值比（OR）及95%置信区间（CI）进行报告。
结果
共纳入300例诊断为脓毒症的患者。其中，232例（77.3%）在30天内存活。未存活病例的年龄显著更大（p = 0.019），氧饱和度更低（92.5%对95.0%；p = 0.003），心率更高（p = 0.001），呼吸频率更高（p < 0.001），意识水平更低（p < 0.001），基于快速序贯器官衰竭评估（qSOFA）评分的疾病严重程度更高（p = 0.001），以及对有创气道管理（p = 0.001）和补充氧气（p = 0.001）的需求更高。院前氧饱和度每增加1%，生存率提高3.5%（调整后的OR = 1.035，95% CI：1.005 - 1.066，p = 0.020），对声音有反应（调整后的OR = 0.170, 95% CI: 0.050 - 0.579, p = 0.005）、对疼痛有反应（调整后的OR = 0.130, 95% CI: 0.036 - 0.475, p = 0.002）和无反应（调整后的OR = 0.086, 95% CI: 0.026 - 0.278, p值< 0.001）的患者的生存概率低于清醒患者。
结论
由EMS团队管理的脓毒症患者的30天生存率为77.3%。院前氧饱和度和意识水平与院前环境中管理脓毒症患者的生存相关。
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