肿瘤合并脓毒症患者的近期和中期预后影响因素分析

Prognostic factors of short-term and mid-term outcome in cancer patients with sepsis

目的探讨肿瘤合并脓毒症患者的近期和中期预后影响因素。方法回顾性分析中国医学科学院北京协和医学院肿瘤医院重症医学科2017年11月至2019年10月收治的260例肿瘤合并脓毒症患者的临床资料。采用单因素和多因素logistic回归分析患者院内死亡的危险因素,采用Cox回归分析影响患者1年生存率的危险因素。结果 260例肿瘤合并脓毒症患者院内死亡20例,院内死亡率7.69%,1年生存率90.0%。单因素分析结果显示,肿瘤控制状态和转入ICU时急性生理学和慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)是院内死亡的危险因素(P<0.01)。多因素logistic回归分析显示,APACHEⅡ评分(P=0.008,RR=1.099,95%CI 1.025~1.178)是肿瘤合并脓毒症患者院内死亡的危险因素。单因素Cox回归发现,肿瘤治疗方式、肿瘤控制状态、APACHEⅡ评分和应用血管收缩药是影响肿瘤合并脓毒症患者1年生存率的危险因素(P分别为0.042、<0.001、0.012、0.046)。多因素Cox回归发现,仅肿瘤控制状态是影响肿瘤合并脓毒症患者1年生存率的危险因素(P=0.004,RR=4.625,95%CI 1.648~12.984)。结论肿瘤合并脓毒症患者的近期预后取决于患者的APACHEⅡ评分,积极治疗可能改善院内生存。肿瘤控制状态是影响肿瘤合并脓毒症患者1年生存率的危险因素。

Objective To investigate the prognostic factors of short-term and mid-term outcomes in cancer patients with sepsis.Method Data of patients who were diagnosed as septic shock in Department of Intensive Care Medicine(ICU)between November 2017 and October 2019 were retrospectively collected and reviewed.Sepsis was diagnosed according to the sepsis-3 definition.Univariable and multivariable Logistic regression analysis were used to define the risk factors of in-hospital death.Univariable and multivariable Cox regression analysis were used to define the risk factors influencing one-year survival.Result There were 20 deaths with hospital death rate of 7.69%.Oneyear survival was 90.2%for all patients.Univariable and multivariable Logistic regression analysis found that only APACHEⅡ(Acute Physiology and Chronic Health EvaluationⅡ)was the risk factor of in-hospital death(P=0.008,RR=1.099,95%CI 1.025-1.178),while cancer control status was not(P=0.075).Univariable and multivariable Cox regression analysis found that only cancer control status was prognostic of one-year survival(P=0.004,RR=4.625,95%CI 1.648-12.984),while model of cancer treatment,APACHEⅡand use of vasopressor were not(all P>0.05).Conclusion In-hospital death depends on disease severity(APACHEⅡ)rather than cancer control status in cancer patients with sepsis,which imply that aggressive treatment may improve short-term outcome of cancer patients with sepsis.Cancer control status is the prognostic factor of one-year survival in cancer patients with sepsis.