Cao Wenhao, Xu Jiuyang, Liu Zhengping, Wang Ziming, Zhang Xueyang, Zhan Qingyuan, Cao Bin
National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
These authors contributed equally as co-first authors.
ERJ Open Res. 2025 Jun 2;11(3). doi: 10.1183/23120541.00836-2024. eCollection 2025 May.
This study attempts to explore the clinical differences of sepsis caused by respiratory viruses and bacteria, and to search for risk factors for mortality in viral sepsis.
This single-centre, retrospective cohort study enrolled patients hospitalised at our medical intensive care unit (ICU) from October 2020 to January 2024 who were diagnosed with pneumonia and sepsis. The primary and secondary pathogens were identified with comprehensive aetiological tests. The baseline clinical information, biochemical tests, treatments and clinical outcomes were collected.
This study included 292 patients, comprising 191 with viral sepsis and 101 with bacterial sepsis. Compared with the bacterial sepsis group, patients with respiratory viral sepsis had lower oxygenation index levels upon ICU admission, higher proportions of acute respiratory distress syndrome (85% 44%; p<0.001), secondary infection (84% 39%; p<0.001) and higher ICU mortality (57% 43%; p=0.018). After adjustment, viral sepsis patients had an odds ratio of 2.26 (95% CI 1.26-4.07) for ICU mortality. Risk factors for ICU mortality in viral sepsis included age, sequential organ failure assessment score, secondary infection, immunocompromised status and coronary heart disease. The subgroup analysis showed that secondary infection in viral sepsis contributed to a poorer clinical outcome.
ICU patients with respiratory viral sepsis presented a higher incidence of unfavourable outcome, which may partially be attributed to secondary infections.
本研究旨在探讨呼吸道病毒和细菌所致脓毒症的临床差异，并寻找病毒性脓毒症患者死亡的危险因素。
本单中心回顾性队列研究纳入了2020年10月至2024年1月在我院医学重症监护病房（ICU）住院且被诊断为肺炎和脓毒症的患者。通过全面的病因学检测确定主要和次要病原体。收集基线临床信息、生化检测结果、治疗情况及临床结局。
本研究共纳入292例患者，其中191例为病毒性脓毒症患者，101例为细菌性脓毒症患者。与细菌性脓毒症组相比，呼吸道病毒性脓毒症患者入住ICU时氧合指数水平较低，急性呼吸窘迫综合征（85%对44%；p<0.001）、继发感染（84%对39%；p<0.001）的比例较高，ICU死亡率也较高（57%对43%；p=0.018）。调整后，病毒性脓毒症患者ICU死亡的比值比为2.26（95%CI 1.26 - 4.07）。病毒性脓毒症患者ICU死亡的危险因素包括年龄、序贯器官衰竭评估评分、继发感染、免疫功能低下状态和冠心病。亚组分析显示，病毒性脓毒症中的继发感染导致临床结局更差。
呼吸道病毒性脓毒症的ICU患者不良结局发生率较高，这可能部分归因于继发感染。
