肝、肾移植患者并发血流感染的死亡危险因素分析

Risk factors for bloodstream infections in liver or kidney transplantation recipients

目的：评价影响伴有血流感染的肝、肾移植患者生存率的可能危险因素。方法：回顾性研究103例肝、肾移植患者发生的138次血流感染，评估导致肝、肾移植术后患者死亡的危险因素。使用单变量分析和多元逻辑回归方法确定危险因素。结果：人选患者年龄12～66（42．3±12．7）岁。绝大多数为院内感染（78．6％），血流感染相关的死亡率为39．8％（41／103）。单变量分析显示以下变量能预测血流感染相关的死亡：腹腔内或胆道感染（P=0．003），混合感染（P〈0．001），肝移植（P〈0．001），血小板计数〈50000／mm3（P〈0．001），感染性休克（P〈0．001）。多元逻辑回归分析显示血小板计数〈S0000／mm3（P=0．002）和感染性休克（P〈0．001）是独立的死亡危险因素。结论：伴有血流感染的肝、肾移植患者死亡率升高的独立危险因素包括血小板计数下降和感染性休克。血流感染一旦发生死亡率极高，预防肝、肾移植术后患者血流感染的发生十分重要。

Objective： To investigate the possible risk factors for death among liver or kidney recipients with bloodstream infections （BSIs）. Methods： A retrospective study of 138 episodes of bloodstream infections documented in 103 patients was conducted to assess potential risk factors for mortality. The risk factors were identified by logistic regression analysis. Results： The mean age of the patients was 12-66 （42.3±12.7） years. The majority of infections were nosocomial （78.6%）. The BSIs-related mortality rate was 39.8% （41/103）. The following variables were identified as risk factors for BSIsorelated mortality by univariate analysis： intra- abdominal/biliary focus （P=0.003）, polymicrobial infection （P〈0.001）, liver transplant （P〈0.001）, platelet count 〈 50000/mm3 （P〈0.001）, and septic shock （P〈0.001）. Platelet count 〈S0000/mm3 （P=0.002） and septic shock （P〈0.001） showed significantly difference between the mortality group and the survival groups in the multivariate logistic regression analysis.Conclusion： Decreased platelet count and septic shock are risk factors for increased mortality in liver or kidney tranplantation recipients with BSIs. The BSIs-related mortality rate is high. Attention should be paid to the prevention of BSIs in liver or kidney transplant patients.