Shi Yue, Tao Tianzhu, Ye Xiaofei, Ye Bo, Mi Weidong, Lou Jingsheng
Department of Anesthesiology, Air Force Medical Center, Beijing, China.
China Medical University, Shenyang, Liaoning, China.
BMJ Open. 2025 Apr 25;15(4):e092310. doi: 10.1136/bmjopen-2024-092310.
To delineate the clinical characteristics and investigate the determinants that may affect the prognosis of surgical patients with abdominal sepsis.
A case-control study was nested in a cohort of surgical patients with abdominal sepsis between 2008 and 2022. We extracted patient' medical records to execute descriptive statistical analyses. Multiple logistic regression models and subgroup analysis were employed to elucidate the risk factors of in-hospital mortality.
Two tertiary hospitals in China.
476 surgical patients diagnosed with abdominal sepsis between 2008 and 2022 were analysed.
None.
Descriptive statistics were used to examine pertinent patient information, including demographic details, laboratory findings, surgical interventions and anaesthetic records. Multivariate logistic regression was used to identify independent risk factors for in-hospital mortality. Subgroup analyses were conducted to explore the impact of specific clinical characteristics on outcomes.
476 patients diagnosed with abdominal sepsis were analysed, exhibiting an in-hospital mortality rate of 7.56%. Advanced age (OR 6.77, 95% CI 2.46 to 18.66, p<0.001), the presence of diabetes (OR 2.61, 95% CI 1.04 to 6.56, p=0.041) and higher preoperative Sequential Organ Failure Assessment (SOFA) score (OR 3.48, 95% CI 1.16 to 10.43, p=0.026) were identified as significant predictors of increased in-hospital mortality risk through a multinomial logistic regression model. Conversely, individuals afflicted with biliary diseases (OR 0.15, 95% CI 0.04 to 0.64, p=0.010) demonstrated a reduced risk of in-hospital mortality. Subgroup analysis revealed that low serum albumin levels emerged as a risk factor for in-hospital mortality in the patients with gastrointestinal diseases (OR 20.23, 95% CI 2.21 to 184.84, p=0.008) or advanced age (OR 10.52, 95% CI 2.29 to 48.31, p=0.002) through multinomial logistic regression analysis.
In this retrospective analysis, we delineated the clinical characteristics of surgical patients with abdominal sepsis and pinpointed risk factors associated with in-hospital mortality. These findings underscore the necessity for more tailored perioperative management strategies for patients with sepsis characterised by advanced age, diabetes, higher preoperative SOFA score and reduced preoperative albumin levels. Clinicians should prioritise early recognition and aggressive management of these high-risk individuals, including timely surgical intervention, optimisation of nutritional status and vigilant monitoring of organ function. These insights underscore the critical role of individualised care in enhancing the prognosis of surgical patients with abdominal sepsis.
ChiCTR2400081823.
描述腹部脓毒症手术患者的临床特征，并研究可能影响其预后的决定因素。
一项病例对照研究嵌套于2008年至2022年间腹部脓毒症手术患者队列中。我们提取患者病历以进行描述性统计分析。采用多重逻辑回归模型和亚组分析来阐明院内死亡的危险因素。
中国的两家三级医院。
分析了2008年至2022年间476例诊断为腹部脓毒症的手术患者。
无。
采用描述性统计分析相关患者信息，包括人口统计学细节、实验室检查结果、手术干预和麻醉记录。使用多变量逻辑回归确定院内死亡的独立危险因素。进行亚组分析以探讨特定临床特征对结局的影响。
分析了476例诊断为腹部脓毒症的患者，院内死亡率为7.56%。通过多项逻辑回归模型确定，高龄（比值比6.77，95%置信区间2.46至18.66，p<0.001）、糖尿病（比值比2.61，95%置信区间1.04至6.56，p=0.041）和术前序贯器官衰竭评估（SOFA）评分较高（比值比3.48，95%置信区间1.16至10.43，p=0.026）是院内死亡风险增加的显著预测因素。相反，患有胆道疾病的个体（比值比0.15，95%置信区间0.04至0.64，p=0.010）院内死亡风险降低。亚组分析显示，通过多项逻辑回归分析，低血清白蛋白水平是胃肠道疾病患者（比值比20.23，95%置信区间2.21至184.84，p=0.008）或高龄患者（比值比10.52，95%置信区间2.29至48.31，p=0.002）院内死亡的危险因素。
在这项回顾性分析中，我们描述了腹部脓毒症手术患者的临床特征，并确定了与院内死亡相关的危险因素。这些发现强调了针对高龄、糖尿病、术前SOFA评分较高和术前白蛋白水平降低的脓毒症患者制定更具针对性的围手术期管理策略的必要性。临床医生应优先对这些高危个体进行早期识别和积极管理，包括及时的手术干预、营养状况的优化和器官功能的密切监测。这些见解强调了个体化护理在改善腹部脓毒症手术患者预后中的关键作用。
ChiCTR2400081823。
