因复杂皮肤及软组织感染住院患者发生脓毒症、入住重症监护病房及死亡的预测因素：在一家大型三级医疗中心进行的回顾性研究。
Predictors of sepsis, intensive care unit admission, and death in patients hospitalized for complicated skin and soft tissue infections: Retrospective study at a large tertiary-care center.
作者信息
Algethamy Haifa M, Alhazmi Rufaydah Nasser, Alghalayini Firyal Kamal, Bahowarth Sarah Yasir, Bukhari Nirmeen M, Alnosani Layan Bandar, Dubaei Samaher Khalid, Sait Razan Abdulelah, Mulla Raghad Abdulaziz, Own Yasser Abdelghaffar, Alshabasy Adel M
机构信息
Faculty of Medicine, Department of Anaesthesia and Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
出版信息
SAGE Open Med. 2025 Apr 26;13:20503121251336069. doi: 10.1177/20503121251336069. eCollection 2025.
BACKGROUND
Complicated skin and soft tissue infections often lead to poor health outcomes, with necrotizing skin and soft tissue infections occurring in 70%-80% of hospitalized patients and a mortality rate typically exceeding 20%. The current study's main objective was to identify early predictors of sepsis, intensive care unit admission, and mortality in hospitalized complicated skin and soft tissue infection patients.
METHODS
A retrospective review of records from 235 adult complicated skin and soft tissue infection patients admitted from 2012 to 2022 was conducted. Collected data included demographics, medical history, clinical presentation, treatment, and outcomes. Laboratory results were used to calculate the Laboratory Risk Indicator for Necrotizing Fasciitis score for diagnosing necrotizing fasciitis. Predictors of sepsis, intensive care unit admission, and death were identified using logistic regression analysis.
RESULTS
Of the 235 patients, 42.1% were wheelchair-bound or bedridden; 93.2% had diabetes, 76.2% had cardiovascular disease, and 33.6% had kidney disease. Necrotizing fasciitis criteria were met by 75% of patients. Sepsis was diagnosed in 27.7% of patients, while 30.6% required intensive care unit admission, and 20.4% did not survive hospital discharge. Low mean arterial pressure and vasopressor use were significant predictors of all three severe outcomes, with pre-existing kidney disease also a predictor of in-hospital death. The Glasgow Coma Scale predicted both intensive care unit admission and sepsis, but not death.
CONCLUSIONS
Low mean arterial pressure, vasopressor use, and pre-existing kidney disease are key predictors of in-hospital death in patients hospitalized for complicated skin and soft tissue infection. The former two, and the patient's Glasgow Coma Scale, also appear to predict both intensive care unit admission and sepsis.
背景
复杂皮肤和软组织感染常常导致不良健康结局，70%-80%的住院患者会发生坏死性皮肤和软组织感染，死亡率通常超过20%。本研究的主要目的是确定住院的复杂皮肤和软组织感染患者发生脓毒症、入住重症监护病房和死亡的早期预测因素。
方法
对2012年至2022年收治的235例成年复杂皮肤和软组织感染患者的记录进行回顾性分析。收集的数据包括人口统计学资料、病史、临床表现、治疗情况及结局。实验室检查结果用于计算坏死性筋膜炎实验室风险指标评分以诊断坏死性筋膜炎。采用逻辑回归分析确定脓毒症、入住重症监护病房和死亡的预测因素。
结果
235例患者中，42.1%需要轮椅辅助或卧床；93.2%患有糖尿病，76.2%患有心血管疾病，33.6%患有肾脏疾病。75%的患者符合坏死性筋膜炎标准。27.7%的患者被诊断为脓毒症，30.6%的患者需要入住重症监护病房，20.4%的患者未存活至出院。平均动脉压低和使用血管活性药物是所有三种严重结局的重要预测因素，既往有肾脏疾病也是住院死亡的预测因素。格拉斯哥昏迷量表可预测入住重症监护病房和脓毒症，但不能预测死亡。
结论
平均动脉压低、使用血管活性药物和既往有肾脏疾病是因复杂皮肤和软组织感染住院患者住院死亡的关键预测因素。前两者以及患者的格拉斯哥昏迷量表似乎也可预测入住重症监护病房和脓毒症。
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