75例重症监护病房假丝酵母菌血症的死亡危险性分析

Risk of Death of 75 Intensive Care Unit Patients with Candidemia:A Retrospective Analysis

目的分析重症监护病房（ICU）患者发生假丝酵母菌血症的临床和微生物特征,并对死亡的危险性进行分析与评估。方法收集2002年4月-2007年3月医院ICU假丝酵母菌血症的临床资料进行回顾性分析;分析其危险因素、基础疾病、假丝酵母菌属的种类、病死率,使用多元回归分析影响预后的危险因素。结果5年间ICU入院6034例,符合假丝酵母菌血症的患者75例,经过对死亡组和生存组各项特征的单因素分析及多因素Logistic回归分析发现,中心静脉导管的留置（97.2%与74.3%,P=0.043,OR=6.4,95%CI为1.06-38.72）;低白蛋白血症（91.7%与56.4%,P=0.020,OR=6.01,95%CI为1.33-27.0）;APACHEⅡ评分（19.6±3.7与15.0±3.8,P=0.00,OR=1.36,95%CI为1.15-1.62）,差异有统计学意义。结论ICU患者假丝酵母菌血症病死率高,中心静脉导管留置、低白蛋白血症、高APACHEⅡ评分是导致假丝酵母菌血症死亡的危险因素。

OBJECTIVE To evaluate mortality prediction by analyzing clinical features and pathogens of patients with candidemia in intensive care unit （ICU）. METHODS The clinical data of candidemia cases admitted to ICU of the First Affiliated Hospital of Zhejiang University in recent five years were analyzed retrospectively, including risk factors, accompanied diseases, Candida species, drug sensitivity, mortality and prognosis. RESULTS Seventy five cases with candidemia were diagnosed in recent five years. Single factor Logistic regression analysis combined with multiple conditional Logistic regression model analysis was conducted. Compared to other risk factors, indwelling central venous catheter（97. 2% vs 74. 3%,P=0. 043,OR=6. 4,95%CI 1. 06-38. 72）, hypoproteinemia （91.7% vs 56. 4% ,P=0. 020,OR=6.01,95%CI 1.33-27.0）and APACHE Ⅱ score （19.6±3.7 vs 15.0±3. 8,P=0.00,OR=1. 36,95% CI 1. 15-1.62） were markedly different. CONCLUSIONS Candidemia cases in ICU increase gradually and lead to higher mortality. Indwelling central venous catheter, hypoproteinemia and APACHE Ⅱ score are related to mortality of candidemia cases.