卒中开颅术后患者脓毒症发生率及其对预后的影响

Incidence of sepsis in post-craniotomy stroke patients and its impact on prognosis

目的探讨卒中开颅术后患者脓毒症的发病率及其对预后的影响。方法本研究为前瞻性、单中心、队列研究。纳入2017年1月1日至2018年12月31日入住北京天坛医院ICU的卒中开颅术后且ICU住院时间≥24 h的成年患者(排除开颅术前合并脓毒症者)。收集患者的基础资料(年龄、性别、基础疾病等),主要诊断,手术相关信息等,对于合并感染和(或)脓毒症的患者,记录感染部位及病原菌。所有患者随访至出院(存活或死亡),记录患者ICU住院时间、总住院时间、住院花费、出院时格拉斯哥预后评分(GOS)等。结果共纳入226例卒中患者,其中男性115例(50.9%),女性111例(49.1%);年龄为(51.6±13.6)岁;因出血性卒中入院者197例(87.2%),因缺血性卒中入院者29例(12.8%)。所有患者中,122例出现感染,76例合并脓毒症,脓毒症发病率为33.6%(95%CI:27.4%~39.8%)。与非脓毒症患者相比,脓毒症患者的ICU住院时间和总住院时间均更长[13(8,22)dvs4(2,7)d,Z=7.994,P<0.001;27(17,38)dvs17(10,25)d,Z=5.579,P<0.001],住院花费更高[140406(100406,217111)yuanvs87034(60102,119352)yuan,Z=6.297,P<0.001]。Logistic回归分析结果显示,脓毒症是患者预后不良(GOS≤3分)的独立危险因素(OR=2.205,95%CI:1.034~4.703,P=0.041)。结论卒中开颅术后患者住院期间合并脓毒症的风险较高;脓毒症不是患者住院期间死亡的危险因素,但可作为预后不良的独立危险因素。

Objective To investigate the incidence of sepsis in post-craniotomy stroke patients and its impact on prognosis of patients.Methods This was a single-center prospective cohort study.All of the adult post-craniotomy stroke patients admitted into the intensive care unit(ICU)ward of Beijing Tiantan Hospital during study period(from January 1,2017 to December 31,2018)and with an ICU length of stay(LOS)longer than 24 hours were eligible.Patients with sepsis before craniotomy were excluded.Demographic and baseline clinical characteristics(age,gender,underlying disease,etc.),information about main diagnosis and surgery were collected.All patients were screened daily for presence of infection and sepsis.For patients with infection and/or sepsis,the infection sites and pathogens were recorded.All patients were followed up until discharge(alive or dead).The ICU LOS,hospital LOS,hospitalization costs,and Glasgow outcome scale(GOS)at discharge were recorded.Results During study period,a total of 226 patients were included,among whom 115(50.9%)were male and 111(49.1%)were female.The mean age was(51.6±13.6)years.Patients with hemorrhagic stroke accounted for 87.2%(n=197),and patients with ischemic stroke accounted for 12.8%(n=29).Of all patients,122 developed infection and 76 developed sepsis.The incidence of sepsis was 33.6%(95%CI:27.4%-39.8%).Compared with non-septic patients,septic patients had longer median ICU LOS[13(8,22)d vs 4(2,7)d,Z=7.994,P<0.001],longer hospital LOS[27(17,38)d vs 17(10,25)d,Z=5.579,P<0.001],and higher hospitalization costs[140406(100406,217111)yuan vs 87034(60102,119352)yuan,Z=6.297,P<0.001].Logistic regression analysis showed that sepsis was not associated with death in stroke patients after craniotomy,but sepsis was an independent risk factor for poor prognosis(GOS≤3 points)(OR=2.205,95%CI:1.034-4.703,P=0.041).Conclusions Patients have a higher risk of complicated sepsis during hospitalization after stroke craniotomy.Sepsis is not a risk factor for death during hospitalization,but can serve as an independent risk factor for poor prognosis.