肝功能衰竭患者发生脓毒症的危险因素

Risk factors for sepsis in patients with hepatic failure

目的分析肝功能衰竭发生脓毒症患者的病原学特点,探讨肝功能衰竭患者发生脓毒症的危险因素.方法回顾性分析2014年1月至2018年12月天津市第二人民医院收治的诊断明确的221例肝功能衰竭患者的临床资料,根据患者是否发生脓毒症分为两组.观察脓毒症患者血培养病原学结果;比较两组患者白细胞计数(WBC)、中性粒细胞比例(Neut)、血小板计数(PLT)、血乳酸(Lac)、C-反应蛋白(CRP)、降钙素原(PCT)水平;采用多因素Logistic回归分析筛选肝功能衰竭患者发生脓毒症的危险因素.结果 221例患者中有27例资料不全,予以排除,最终194例患者纳入分析,其中脓毒症组52例,非脓毒症组142例.2014至2018年每年肝功能衰竭脓毒症患者血培养阳性例数分别为11、12、11、11和8例,其中革兰阳性菌(G+菌)阳性比例呈逐年升高趋势(2014至2018年每年G+菌阳性例数分别为2、3、4、5和4例).两组患者性别、年龄、糖尿病史等人口学和病史资料比较差异均无统计学意义.与非脓毒症组比较,脓毒症组患者Neut、Lac、CRP、PCT均明显升高〔Neut:0.81±0.09比0.74±0.15,Lac(mmol/L):3.04±0.61比2.00±0.43,CRP(mg/L):44.09±8.37比40.54±8.37,PCT(μg/L):0.34±0.12比0.31±0.11〕,差异均有统计学意义(均P<0.05);而两组WBC、PLT比较差异均无统计学意义.将单因素分析中差异有统计学意义的指标纳入Logistic回归模型,结果显示,Lac是肝功能衰竭患者发生脓毒症的独立危险因素〔优势比(OR)=58.286,95%可信区间(95%CI)=16.633~204.247, P=0.000〕.结论肝功能衰竭脓毒症血培养G+菌比例有逐年升高的趋势;Lac升高是肝功能衰竭患者发生脓毒症的独立危险因素.

Objective To analyze the pathogenic characteristics of sepsis in patients with hepatic failure, and to explore the risk factors for sepsis in patients with liver failure. Methods The data of 221 patients with hepatic failure admitted to Tianjin Second People's Hospital from January 2014 to December 2018 were retrospectively collected. The patients were divided into two groups according to whether they suffered from sepsis or not. The pathogeny results of blood culture in patients with sepsis were observed. The levels of white blood cell (WBC), neutrophil (Neut), platelet (PLT), lactic acid (Lac), C-reactive protein (CRP) and procalcitonin (PCT) were compared between the two groups. The risk factors for sepsis in patients with hepatic failure were analyzed by multivariate Logistic regression analysis. Results Among 221 patients, 27 cases had incomplete data and were excluded. Finally, 194 cases were enrolled in the analysis, including 52 in sepsis group and 142 in non-sepsis group. From 2014 to 2018, there were 11, 12, 11, 11 and 8 positive cases of sepsis in patients with liver failure. The positive rate of Gram-positive (G+) bacteria increased year by year (2, 3, 4, 5 and 4 cases of G+ bacteria from 2014 to 2018). There was no significant difference in demographic and medical history data, such as gender, age and history of diabetes mellitus between the two groups. Compared with non-sepsis group, Neut, Lac, CRP and PCT in sepsis group were significantly increased [Neut: 0.81±0.09 vs. 0.74±0.15, Lac (mmol/L): 3.04±0.61 vs. 2.00±0.43, CRP (mg/L): 44.09±8.37 vs. 40.54±8.37, PCT (μg/L): 0.34±0.12 vs. 0.31±0.11], with significant differences (all P < 0.05). But there was no statistical difference in WBC or PLT between the two groups. The multivariate Logistic regression model incorporated the indicators with statistical significance in univariate analysis. The results showed that Lac was an independent factor of sepsis in patients with hepatic failure [odds ratio (OR)= 58.286, 95% confidence interval (95%CI)= 16.633-204.247, P = 0.000]. Conclusions For patients with hepatic failure infection, the ratio of G+ bacteria increased year by year. Elevated Lac is an independent risk factor for sepsis in patients with liver failure.