脓毒症患者发生应激性溃疡的危险因素及预后分析

Risk factors and prognosis of stress ulcer in patients with sepsis

目的探讨脓毒症患者住院期间发生应激性溃疡(stress ulcer,SU)的危险因素及其对预后的影响。方法回顾性选择2019年1月至2021年7月复旦大学附属中山医院急诊科重症监护室收治的脓毒症患者344例,根据有无发生SU分为溃疡组和未溃疡组。采用logistic回归模型评估脓毒症患者发生SU及28 d死亡的危险因素,采用ROC曲线评估相关指标对脓毒症患者28 d死亡的预测价值。结果344例脓毒症患者中发生SU 80例,占23.3%。部分促炎细胞因子(IL-6、IL-8)在溃疡组显著升高(P<0.05)。APACHEⅡ评分是脓毒症患者发生SU的影响因素(OR=1.066,95%CI 1.030~1.103,P<0.001);呼吸衰竭(OR=3.408,95%CI 1.604~7.239,P<0.001)、尿素氮升高(OR=1.046,95%CI 1.003~1.090,P<0.05)、休克(OR=2.427,95%CI 1.145~5.144,P<0.05)是脓毒症患者发生SU的独立危险因素。溃疡组和未溃疡组28 d死亡率为26.3%(21/80)和6.4%(17/264),差异有统计学意义(P<0.001)。发生SU与否和APACHEⅡ评分是脓毒症患者28 d死亡的独立影响因素(P<0.01),联合发生SU和APACHEⅡ评分预测脓毒症患者28 d死亡的AUC为0.799(P<0.001)。结论发生SU的脓毒症患者炎症反应常更显著,SU的发生是多种因素共同作用的结果,早期识别并纠正可逆性因素可能有助于改善脓毒症患者的预后。

Objective To explore the risk factors of stress ulcer(SU)in sepsis patients during hospitalization and its influence on the prognosis.Methods A total of 344 sepsis patients admitted to the Department of Emergency Intensive Care Unit(EICU)of Zhongshan Hospital,Fudan University from January 2019 to July 2021 were enrolled,and were divided into SU group and NSU group according to the presence or absence of SU.Logistic regression model was used to evaluate the risk factors of SU and 28-day death in sepsis patients,and ROC curve was used to evaluate the predictive value of related indicators for 28-day death in sepsis patients.Results Among 344 patients with sepsis,80 cases(23.3%)had SU.Some pro-inflammatory cytokines(IL-6、IL-8)were significantly increased in the SU group(P<0.05).APACHEⅡscore was the influence factor for SU in sepsis patients(OR=1.066,95%CI 1.030-1.103,P<0.001),and respiratory failure(OR=3.408,95%CI 1.604-7.239,P<0.001),blood urea nitrogen increasing(OR=1.046,95%CI 1.003-1.090,P<0.05),shock(OR=2.427,95%CI 1.145-5.144,P<0.05)were independent risk factors for SU in septic patients(P<0.05).The 28-day mortality in the SU group was 26.3%(n=21),and in the NSU group was 6.4%(n=17,P<0.001).APACHEⅡscore and the SU occurrence or not were independent influence factors for 28-day mortality of septic patients(P<0.01).The AUC of combined SU and APACHEⅡscore for 28-day death of sepsis patients was 0.799(P<0.001).Conclusion The inflammatory response in sepsis patients with SU is often more severer.The occurrence of SU is affected by many factors.Early identification and correction of reversible factors may improve the prognosis of patients with sepsis.