严重脓毒症患者预后的危险因素分析

Risk factors on prognosis of patients with severe sepsis

目的:探讨综合重症监护病房(ICU)重度脓毒症患者的临床特点及其死亡危险因素。方法:回顾性分析2013-01-2015-12我院重症医学科收治的严重脓毒症患者448例的临床特征。按入院至28d的不同预后分为死亡组与存活组,并进行对照分析。采用Logistic回归模型进行单因素和多因素的分析,明确重度脓毒症死亡的独立危险因素。结果:重度脓毒症的ICU病死率为49.33%(221/448)。生存和死亡组的年龄、APACHEⅡ、MAP、WBC、Alb、SCr、PaO_2、血钾和血糖9个指标的比较差异有统计学意义。单因素回归分析显示,年龄(OR=2.649,P<0.01)、APACHEⅡ评分(OR=2.058,P<0.05)、PaO_2(OR=0.979,P<0.01)、PT(OR=1.097,P<0.05)、WBC(OR=0.907,P=0.01)、PLT(OR=1.004,P<0.05)、TB(OR=0.983,P<0.05)、Alb(OR=1.104,P<0.001)、SCr(OR=0.990,P<0.01)和血糖(OR=0.846,P<0.01)10个指标为影响重症脓毒症预后的相关因素,其中年龄、APACHEⅡ评分、PT、PLT和Alb 5个指标为预后的危险因素,PaO_2、WBC、TB、SCr和血糖5个指标为预后的非危险因素。多因素Logistic回归分析显示,年龄(OR=0.933,P<0.01)、APACHEⅡ评分(OR=0.950,P<0.05)、血糖(OR=0.856,P<0.01)、A1b(OR=1.101,P<0.01)、WBC(OR=0.899,P<0.001)、PLT(OR=1.002,P<0.05)、SCr(OR=0.992,P<0.01)、TB(OR=0.985,P<0.05)、PaO_2(OR=0.978,P<0.01)和PT(OR=1.111,P<0.01)为影响重症脓毒症预后的相关因素。结论:年龄、APACHEⅡ评分、血糖、A1b、WBC、PLT、SCr、TB、PaO_2和PT是临床上判断危重病患者预后的有效指标。

Objective：To investigate the clinical feature and the risk factors of mortality on the patients with severe sepsis.Method：Clinical data of 448 cases with severe sepsis in ICU from January 2013 to December 2015 were studied retrospectively.These subjects were divided into death group and survival group according to their different prognosis from admission to 28 th days of admission and contrastive analysis was took.Logistic regression analysis of single factor and multiple factor were employed to identify independent risk factors for the death of patients with severe sepsis.Result：ICU mortality of severe sepsis was 49.33%（221/448）.There were statistical difference between death group and survival group on nine index such as age,APACHE Ⅱ score,MAP,WBC,Alb,SCr,POa2,serous potassium and blood sugar.Single factor regression analysis showed that ten index such as age（OR=2.649,P〈0.01）,APACHEⅡscore（OR=2.058,P〈0.05）,PaO2（OR=0.979,P〈0.01）,PT（OR=1.097,P〈0.05）,WBC（OR=0.907,P=0.01）,PLT（OR=1.004,P〈0.05）,TB（OR=0.983,P〈0.05）,Alb（OR=1.104,P〈0.01）,SCr（OR=0.990,P〈0.01）and blood sugar（OR=0.846,P〈0.01）were correlative factors impacting the prognosis of severe sepsis.Age,APACHE Ⅱ score,PT,PLT and Alb were crisis factors and PaO2,WBC,TB,SCr and blood sugar were non crisis factor of severs sepsis among them.Multiple Logistic regression analysis showed that age（OR=0.933,P〈0.01）,APACHE Ⅱ score（OR=0.950,P〈0.05）,blood sugar（OR=0.856,P〈0.01）,Alb（OR=1.101,P〈0.01）,WBC（OR=0.899,P〈0.01）,PLT（OR=1.002,P〈0.05）,SCr（OR=0.992,P〈0.01）,TB（OR=0.985,P〈0.05）,PaO2（OR=0.978,P〈0.01）and PT（OR=1.111,P〈0.01）were correlative factors impacting the prognosis of severe sepsis.Conclusion：Age,APACHE Ⅱscore,blood sugar,Alb,WBC,PLT,SCr,TB,PaO2 and PT were effective index judging the prognosis of severe sepsis.