APACHEⅡ和PITT评分对急诊老年社区发病的血流感染预后的预测价值

Prognostic value of APACHEⅡ score and PITT score in the elderly community-onset bloodstream infection in emergency department

目的分析急诊老年社区发病的血流感染(COBSI)患者的病原菌分布特点和耐药性及APACHEⅡ和PITT评分对预后的预测价值。方法采用回顾性研究方法,选择2015年1月1日至2020年1月1日期间北京积水潭医院急诊科符合COBSI诊断且病历资料完整的356例老年患者。结果根据90 d存活与否,将患者分为生存组和死亡组。单因素分析显示,实体恶性肿瘤、慢性肾脏疾病、脓毒性休克、急性肾功能不全、急性肝功能不全、感染前中心静脉插管、留置尿管、肾脏替代治疗、其他侵入性治疗、PITT评分、APACHEⅡ评分及住院时间在生存组与死亡组间差异有统计学意义(P<0.05)。APACHEⅡ评分、PITT评分对急诊老年COBSI预后有较好的预测价值。PITT评分预测价值更优。APACHEⅡ评分、PITT评分的cut-off值分别为16.5和3.5。结论急诊老年COBSI患者合并实体恶性肿瘤、慢性肾脏疾病、脓毒性休克、急性肾功能不全、急性肝功能不全、感染前中心静脉插管、留置尿管、肾脏替代治疗、其他侵入性治疗者预后差。APACHEⅡ评分、PITT评分对急诊老年COBSI预后有较好的预测价值。

Objective To analyze the distribution characteristics and drug resistance of pathogenic bacteria in the elderly community-onset bloodstream infection(COBSI) and the predictive value of different scores in the prognosis.Methods A retrospective study was conducted in 356 elderly patients with COBSI diagnosed in the emergency department of Beijing Jishuitan Hospital from January 1,2015 to January 1,2020.Results The patients were divided into survival group and death group according to 90-day survival.Univariate analysis showed that there were significant differences in solid malignant tumor, chronic kidney disease, septic shock, acute renal insufficiency, acute liver insufficiency,central venous catheterization before infection,indwelling catheter,renal replacement therapy,other invasive treatment,Pitt bactermia score(PITT),acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) and hospital stay between survival group and death group(P < 0.05).APACHEⅡ score and PITT score had good predictive value for the prognosis of COBSI.The predictive value of PITT score was better.The cut-off values of APACHEⅡ score and PITT score were 16.5 and 3.5 respectively.Conclusions In the emergency department,the prognosis is poor in the elderly COBSI patients complicated with solid malignant tumor,chronic kidney disease,septic shock,acute renal insufficiency,acute liver insufficiency,central venous catheterization before infection,indwelling catheter,renal replacement therapy and other invasive therapy.APACHEⅡ score and PITT score have good predictive value for the prognosis of elderly patients with COBSI.