Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City, Taiwan.
Graduate Institute of Clinical Medical Sciences; Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Medicine (Baltimore). 2024 May 17;103(20):e38114. doi: 10.1097/MD.0000000000038114.
Early identification of the sources of infection in emergency department (ED) patients of sepsis remains challenging. Computed tomography (CT) has the potential to identify sources of infection. This retrospective study aimed to investigate the role of CT in identifying sources of infection in patients with sepsis without obvious infection foci in the ED. A retrospective chart review was conducted on patients with fever and sepsis visiting the ED of Linkou Chang Gung Memorial Hospital between July 1, 2020 and June 30, 2021. Data on patient demographics, vital signs, clinical symptoms, underlying medical conditions, laboratory results, administered interventions, length of hospital stay, and mortality outcomes were collected and analyzed. Of 218 patients included in the study, 139 (63.8%) had positive CT findings. The most common sources of infection detected by CT included liver abscesses, acute pyelonephritis, and cholangitis. Laboratory results showed that patients with positive CT findings had higher white blood cell and absolute neutrophil counts and lower hemoglobin levels. Positive blood culture results were more common in patients with positive CT findings. Additionally, the length of hospital stay was longer in the group with positive CT findings. Multivariate logistic regression analysis revealed that hemoglobin levels and positive blood culture results independently predicted positive CT findings in patients with fever or sepsis without an obvious source of infection. In patients with sepsis with an undetermined infection focus, those presenting with leukocytosis, anemia, and elevated absolute neutrophil counts tended to have positive findings on abdominal CT scans. These patients had high rates of bacteremia and longer lengths of stay. Abdominal CT remains a valuable diagnostic tool for identifying infection sources in carefully selected patients with sepsis of undetermined infection origins.
在急诊科（ED）脓毒症患者中，早期识别感染源仍然具有挑战性。计算机断层扫描（CT）具有识别感染源的潜力。本回顾性研究旨在探讨 CT 在识别 ED 中无明显感染灶的脓毒症患者感染源中的作用。对 2020 年 7 月 1 日至 2021 年 6 月 30 日期间因发热和脓毒症就诊于林口长庚纪念医院 ED 的患者进行了回顾性图表审查。收集并分析了患者的人口统计学数据、生命体征、临床症状、基础疾病、实验室结果、给予的干预措施、住院时间和死亡率。在纳入的 218 例患者中，139 例（63.8%）CT 检查阳性。CT 检测到的最常见感染源包括肝脓肿、急性肾盂肾炎和胆管炎。实验室结果显示，CT 检查阳性患者的白细胞和绝对中性粒细胞计数较高，血红蛋白水平较低。CT 检查阳性患者的血培养阳性结果更为常见。此外，CT 检查阳性组的住院时间更长。多变量逻辑回归分析显示，血红蛋白水平和血培养阳性结果独立预测发热或脓毒症且无明显感染源患者 CT 检查阳性。对于原因不明的感染患者，出现白细胞增多、贫血和绝对中性粒细胞计数升高的患者腹部 CT 扫描结果阳性的可能性更大。这些患者菌血症发生率较高，住院时间较长。腹部 CT 仍然是确定原因不明感染起源的脓毒症患者感染源的有价值的诊断工具。
