感染部位与发生脓毒症肝损伤的相关性研究

Correlation between the sites of infection and the occurrence of sepsis-related liver injury

目的:研究不同感染部位与发生脓毒症相关肝损伤(SRLI)的相关性,为尽早识别SRLI提供依据。方法:本研究为回顾性病例对照研究,分析2017年6月—2020年6月入住我院急诊重症监护病房脓毒症患者的临床资料,将患者分为SRLI组和对照组。比较两组患者的年龄、性别及入科时的SOFA评分、乳酸及MELD评分。计算不同感染部位对SRLI发生的影响。比较两组患者住EICU时间、住EICU费用、28 d病死率及180 d累积生存率。结果:共纳入1126例脓毒症患者,SRLI组155例(13.8%),对照组971例(86.2%)。SRLI组血液培养(14.4%vs.9.5%,P<0.001),腹水培养(10.4%vs.5.9%,P<0.001)和胆汁培养(9.0%vs.4.1%,P<0.001)的阳性率明显高于对照组。胆系感染(OR=6.340,95%CI:4.842~9.032,P<0.001)、腹腔感染(OR=4.391,95%CI:3.098~5.390,P=0.012)和血流感染(OR=2.494,95%CI:1.874~2.933,P<0.001)与SRLI的发生密切相关。SRLI组患者的住EICU时间(12.2 d vs.9.4 d,P<0.001)及费用(13.6万元vs.10.8万元,P=0.031)均高于对照组,且SRLI组患者具有较高的28 d病死率(38.1%vs.18.9%,P<0.001)。对照组180 d累计生存率显著高于SRLI组(Log Rank=13.629;P<0.001)。结论:当脓毒症患者的感染部位为胆道系统、腹腔或血液时,应警惕SRLI的发生。当脓毒症患者发生SRLI时,应首先考虑上述部位感染。

Objective:To study the correlation between infection sites and the occurrence of sepsis-related liver injury(SRLI)to provide evidence for the early identification of SRLI.Methods:This study is a retrospective case-control study.The clinical data of sepsis patients admitted to our hospital’s emergency intensive care unit from June 2017 to June 2020 were analyzed,and the patients were divided into SRLI group and control group.The age,gender and SOFA score,lactate concentration and MELD score at admission of the two groups were compared.We calculated the correlation between infection sites and the occurrence of SRLI.The duration of staying in EICU,cost of staying in EICU,28-day mortality rate and 180-day cumulative survival rate were compared between the two groups.Results:A total of 1126 sepsis cases were included,155 cases(13.8%)in the SRLI group,and 971 cases(86.2%)in the control group.The positive rates of blood culture(14.4%vs.9.5%,P<0.001),ascites culture(10.4%vs.5.9%,P<0.001)and bile culture(9.0%vs.4.1%,P<0.001)in the SRLI group were significantly higher than those of the control group.Biliary infection(OR=6.340,95%CI:4.842-9.032,P<0.001),abdominal cavity infection(OR=4.391,95%CI:3.098-5.390,P=0.012)and bloodstream infection(OR=2.494,95%CI:1.874-2.933,P<0.001)is closely related to the occurrence of SRLI.The duration of staying in the EICU(12.2 days vs.9.4 days,P<0.001)and expenses(136,000 yuan vs.108,000 yuan,P=0.031)of patients in the SRLI group were higher than those of the control group,and patients in the SRLI group had a higher 28-day mortality(38.1%vs.18.9%,P<0.001).The 180-day cumulative survival rate of the control group was significantly higher than that of the SRLI group(Log Rank=13.629;P<0.001).Conclusion:SRLI should be considered for sepsis patients whose infection sites are the biliary system,abdominal cavity or blood.When SRLI occurs in patients with sepsis,the infection sites of biliary system,abdominal cavity and blood should be considered first.