终末期肝病合并血流感染病人预后影响因素

Influencing factors on the prognosis of patients with end-stage liver disease and bloodstream infection

目的探究终末期肝病合并血流感染病人预后的影响因素。方法回顾性收集2013年1月至2018年8月徐州医科大学附属医院收治的终末期肝病合并血流感染病人(n=139例)的临床数据。根据病人出院时治疗效果,分为有效组(n=105例)和无效组(n=34例)。采用单因素分析和多因素logistic回归分析终末期肝病合并血流感染病人不同临床结局的影响因素。结果入组病人共139例,其中有效组病人105例(75.5%),无效组病人共34例(24.5%)。单因素分析提示,住院时间[18.50(14.00,25.00)d比12.00(3.00,25.25)d]、终末期肝病模型(MELD)评分[(13.50±7.30)分比(20.40±11.70)分]、MELD评分结合血清钠浓度(MELD-Na评分)[(11.49±12.71)分比(24.15±19.55)分]、肝衰竭(23.8%比61.8%)、24 h体温改善情况(59.0%比38.2%)、是否并发肝肾综合征(0%比14.7%)及感染性休克(0%比11.8%)在有效组和无效组间差异有统计学意义(均P<0.05)。多因素logistic回归分析提示,肝病进展为肝衰竭[OR=3.820,95%CI:(1.437,10.156)]、既往有腹膜炎病史[OR=3.499,95%CI:(1.007,12.155)]、24 h内体温改善情况[OR=2.826,95%CI:(1.117,7.147)]、MELD-Na评分[OR=1.039,95%CI:(1.007,1.072)]是影响终末期肝病合并血流感染病人治疗效果的独立影响因素(均P<0.05)。结论肝衰竭、既往有腹膜炎病史、24 h内体温未改善、高MELD-Na评分是终末期肝病合并血流感染病人临床治疗无效的独立危险因素。

Objective To investigate the prognostic factors of patients with end-stage liver disease complicated with bloodstream infection.Methods The clinical data of patients with end-stage liver disease and bloodstream infection admitted to the Xuzhou Medical University Affiliated Hospital from January 2013 to August 2018 were retrospectively collected.The patients were divided into an effective group and an ineffective group according to the treatment effect at the time of discharge from the hospital.Univariate analysis and multivariate logistic regression were used to analyze the prognostic factors of different clinical outcomes in patients with end-stage liver disease and bloodstream infection.Results A total of 139 patients were enrolled,including 105 patients(75.5%)in the effective group and 34 patients(24.5%)in the ineffective group.Univariate analysis suggested that hospital days[18.50(14.00,25.00)d vs.12.00(3.00,25.25)d],Model for End-Stage Liver Disease(MELD)score(13.50±7.30)vs.(20.40±11.70),MELD with incorporation of sodium(MELD-Na)score(11.49±12.71)vs.(24.15±19.55),liver failure(23.8%vs.61.8%),24-hour body temperature improvement(59.0%vs.38.2%),hepatorenal syndrome(0%vs.14.7%)and septic shock(0%vs.11.8%)were statistically different between the effective and ineffective groups(all P<0.05).Multivariate logistic regression analysis indicated that liver failure[OR=3.820,95%CI:(1.437,10.156)],a history of peritonitis[OR=3.499,95%CI:(1.007,12.155)],body temperature improvement within 24 hours[OR=2.826,95%CI:(1.117,7.147)],and MELD-Na score[OR=1.039,95%CI:(1.007,1.072)]are independent factors affecting the treatment effect of patients with end-stage liver disease and bloodstream infection(all P<0.05).Conclusion Liver failure,past history of peritonitis,unimproved body temperature within 24 hours,and high MELD-Na score are independent risk factors for clinical treatment failure in patients with endstage liver disease and bloodstream infection.