严重感染患者死亡危险因素的Logistic回归分析

Logistic regression analysis on fatal risk factors to patients with sepsis

目的研究严重感染患者死亡的危险因素。方法对北京协和医院重症监护室(ICU)连续收治的严重感染患者进行分析。记录患者的一般情况与临床资料,检测患者单核细胞人白细胞抗原DR(HLA-DR)、血二胺氧化酶(DAO)等指标。对上述资料进行单因素分析,选择有意义的变量(P<0.05)进行多因素非条件Logistic回归分析。主要研究终点为住院28d患者病死率。结果2003年8月-2004年1月为期6个月内共有49例严重感染患者入选研究,其中男性32例(65.3%),女性17例(34.6%),年龄60.8±16.9岁;APACHEⅡ评分18.6±8.0分,序贯性器官功能衰竭评分(SOFA)5.9±3.8分,来自非手术科室患者21例(42.9%),来自手术科室患者28例(57.1%),住ICU天数14.4±12.8d,28d住院病死率为36.7%(18/49)。单因素分析结果显示血培养阳性、HLA-DR降低、血小板计数下降和血DAO升高与住院病死率有关。Logistic回归分析显示血培养阳性(OR=5.237,95%CI1.041～26.34,P=0.045)、HLA-DR降低(OR=0.943,95%CI0.901～0.98,P=0.010)和血DAO活性升高(OR=2.235,95%CI1.101～4.53,P=0.026)是影响住院病死率的独立危险因素。结论伴有血培养阳性、HLA-DR降低和外周血DAO活性升高的严重感染患者死亡的风险较高。

Objective To study the fatal risk factors to the patients with sepsis.Methods The data of 49 patients with sepsis were analyzed,who were consecutively admitted to intensive care unit（ICU）of Peking Union Medical College Hospital within six months.Patients＇ general states,clinical information,human leucocyte antigen-DR（HLA-DR）in blood monocytes and plasma level of diamine oxidase（DAO）were recorded.Simple logistic regression was done to analyze all the risk factors,and statistically significant variables were selected and used in multivariate and unconditioned Logistic regression analysis.The primary end point was hospital mortality.Results The subjects involved in present study were consisted of 49 patients with sepsis admitted to ICU of the Peking Union Medical College Hospital from Aug.2003 to Jan.2004,averagely aged 60.8±16.9 years;including 32 males（65.3%）and 17 females（34.7%）;with APACHEⅡscores 18.6±8.0 and SOFA scores 5.9±3.8.Twenty-one out of the 49 patients（42.9%）were from non-operation department,and the other 28 patients（57.1%）were from operation department.ICU duration was 14.4±12.8 days;eighteen of the 49 septic patients died during hospitalization,with the 28-days mortality of 36.7%.Positive blood cultures（OR=5.237,95%CI 1.041~26.34,P=0.045）,decreased platelet count and blood HLA-DR（OR=0.943,95%CI 0.901~0.98,P=0.01）,and increased plasma levels of DAO（OR=2.235,95%CI 1.101~4.53,P=0.026）were obviously associated with mortality.The positive blood cultures,decreased blood HLA-DR and increased plasma levels of DAO were independent fatal risk factors for the patients with sepsis.Conclusions The positive blood cultures,decreased blood HLA-DR and increased plasma levels of DAO are high risk for the patients with sepsis at admission.