革兰阳性球菌血流感染预后危险因素分析

Prognotic Risk Factors of Gram Positive Coccus Bloodstream Infection

目的探讨影响革兰阳性球菌血流感染患者预后的危险因素。方法采用回顾性研究方法,选择我院2013年1月至2015年4月收治的革兰阳性球菌血流感染患者93例。根据28 d生存情况将患者分为存活组和死亡组,收集患者一般临床资料、基础疾病、有创操作等,通过多因素Logistic回归分析确定独立危险因素。结果死亡组患者的白蛋白水平低于存活组(P<0.05),D-二聚体、APACHEⅡ评分、合并机械通气、深静脉置管的比例明显高于存活组(P<0.05)。肠球菌血流感染患者合并糖尿病、外科术后、肿瘤、肾功能衰竭比例均高于其他球菌组(P<0.05),但与金黄色葡萄球菌组比较上述合并症比例无明显差异(P>0.05)。ROC曲线分析提示APACHEⅡ评分和白蛋白预测28 d病死率的ROC曲线下面积(AUC)最大值分别0.768和0.775,以APACHEⅡ评分>22.5分作为预测28 d死亡的临界点,敏感性为70.0%,特异性为81.2%;以白蛋白<32.5 g/L作为预测28 d死亡的临界点,敏感性为55.3%,特异性为86.7%。28 d病死率Logistic多因素分析显示仅低白蛋白水平是预测革兰阳性球菌血流感染28 d病死率的独立预后指标(P<0.05)。结论合并糖尿病、外科术后、肿瘤、肾功能衰竭的患者需警惕肠球菌感染,低白蛋白血症提示革兰阳性球菌血流感染预后不良。

Objective To explore the prognostic risk factors for patients with gram positive coccus bloodstream infections. Methods By retrospective analysis, 93 patients with gram positive coccus bloodstream infections were recruited fromthe China-Japan Friendship Hospital during January 2013 to April 2015. According to the 28-day survival situation, the patients were divided into a survival group and a death group. The clinical data including basic diseases and invasive operation were collected. Logistic regression analysis was used to evaluate the risk factors for predicting prognosis. Results The albumin concentration in the death group was lower than that in the survival group （ P 〈 0. 05 ） . The D-Dimer concentration, APACHEⅡ scores, the percentage of patients with mechanical ventilation, and the percentage of patients with deep venous cannels in the death group were all higher than those in the survival group （ P 〈 0. 05） . The percentages with diabetes mellitus, surgery, tumor, renal failure in the patients with enterococcus bloodstream infections were much higher than those patients with other grampositive coccus bloodstream infections （ P 〈 0. 05） , but were not different with those patients with Staphylococcus aureus bloodstream infection （ P 〉 0. 05） . The APACHEⅡ score and albumin concentration had statistical significance for predicting the 28-day and 90-day mortality. The area under the receiver operating characteristic （ ROC） curve was 0. 768 and 0. 775. If using APACHEⅡ score 〉22. 5 as cut off value for predicting death in 28 days, the sensitivity was 70. 0%, and the specificity was 81. 2% . If Using albumin concentration 〈 32. 5 g/L as a cutoff value for predicting death in 28 days, the sensitivity was 55. 3% , and the specificity was 86. 7% . The logistic multifactor analysis revealed only the lower albumin concentration was an independent prognostic factor for 28-day mortality of the patients with gram positive coccus bloodstream infections （ P 〈 0. 05） . Conclusions The patients with diabetes mellitus, surgery, tumor, and renal failure need to be cautious of enterococcus bloodstream infection. The lowalbumin concentration suggests a poor prognosis in patients with gram positive coccus bloodstream infections.