尿源性脓毒血症死亡因素的回顾性分析

Retrospective analysis of the mortality factors of urinary sepsis

目的分析影响尿源性脓毒血症死亡的危险因素。方法回顾性分析302例尿源性脓毒血症患者的病例资料。患者院内死亡或者出院后30天内死亡的病例纳入死亡组,其他纳入存活组。比较两组人口统计学资料、临床和实验室资料,采用多变量Logistic回归分析。结果两组糖尿病、年龄、查尔森合并症指数(CCI)、入院时神志改变、入院时快速感染相关器官衰竭评分系统评分(qSOFA)、发病时呼吸频率、发病时神志改变、发病时qSOFA有统计学意义(P<0.05)。死亡组患者诊断当天感染相关器官衰竭评分系统评分(SOFA)、中枢神经系统(CNS)评分、心血管评分较存活组升高(P<0.05)。诊断第2天和诊断第3天,死亡组SOFA较存活组升高更显著(P<0.05)。两组脑钠肽、肌酐、血钾、尿素氮、血浆渗透压、尿RBC、尿WBC、尿蛋白有统计学意义。Logistic分析结果显示,死亡独立预测因素为发病时CNS评分、诊断第3天SOFA升高值和诊断当天尿WBC。结论尿源性脓毒血症患者发病时的CNS评分、诊断第3天SOFA升高值和诊断当天尿WBC是患者死亡的独立预测因素。

Aim To analyze the risk factors for urinary sepsis death.Methods The clinical data of 302 patients with urine-derived sepsis were retrospectively analyzed.Patients were classified as death group based on in-hospital death or death within 30 days after discharge,and others were survival group.Demographic,clinical,and laboratory data were compared between the two groups,and multivariate Logistic regression analysis was performed.Results Diabetes mellitus,age,Charleson comorbidity index(CCI),consciousness at admission,qSOFA score at admission,number of breaths at onset,consciousness at onset and qSOFA at onset in two groups were statistically significant(P<0.05).The scores of infection-related organ failure score(SOFA),central nervous system score(CNS score)and cardiovascular score in the death group on diagnosis day were higher than those in the survival group(P<0.05).On the second and third day of diagnosis,SOFA increased more significantly in the death group than in the survival group(P<0.05).Brain natriuretic peptide,creatinine,blood potassium,urea nitrogen,plasma osmotic pressure,urinary RBC,urinary WBC and urinary protein in two groups were statistically significant.Logistic analysis showed that the independent predictors of death were CNS score at onset,SOFA elevation on diagnosis day 3,and urinary WBC on diagnosis day.Conclusion CNS score at onset,SOFA elevation on day 3 of diagnosis,and urinary WBC on day 3 of diagnosis were the most important factors affecting the death of patients with urine-derived sepsis.