细菌性肝脓肿并发脓毒症进展为脓毒性休克相关危险因素及预后分析

Risk factors and prognosis of bacterial liver abscess complicated with sepsis progressing to septic shock

目的探讨细菌性肝脓肿(BLA)并发脓毒症进展为脓毒性休克相关危险因素及预后。方法采用回顾性病例对照研究方法,从湖南省人民医院病历系统中收集2019年1月至2022年6月BLA并发脓毒症患者100例,按是否发生休克分为休克组(40例)与非休克组(60例)。分析比较2组患者的一般资料、入院首次实验室检查指标、病原学检测结果和结局指标。采用单因素Logistic回归分析BLA并发脓毒症进展为脓毒症休克的危险因素。结果休克组血乳酸、降钙素原、总胆红素、直接胆红素水平均高于非休克组(均P<0.05)。休克组急性肾功能不全发生率、病死率均高于非休克组[25.0%(10/40)比8.3%(5/60)、22.5%(9/40)比3.3%(2/60),均P<0.05]。单因素Logistic回归分析结果显示降钙素原、血乳酸、总胆红素、直接胆红素均为BLA并发脓毒症进展为脓毒性休克的危险因素(均P<0.05)。结论降钙素原、血乳酸、总胆红素、直接胆红素水平是BLA并发脓毒症进展为脓毒性休克的危险因素,与患者预后相关,监测其水平变化对临床医师决策治疗方案及判断预后有重要意义。

Objective To investigate the risk factors and prognosis of bacterial liver abscess(BLA)complicated with sepsis progressing to septic shock.Methods From January 2019 to June 2022,100 patients with BLA complicated with sepsis from the medical record system of Hunan Provincial People′s Hospital were collected by a retrospective case-control study.According to the occurrence of shock,patients were divided into shock group(40 cases)and non-shock group(60 cases).The general data,laboratory inspection indicators at the first admission,pathogen test results and outcome indicators between the two groups were analyzed and compared.Univariate Logistic regression was used to analyze the risk factors of BLA complicated with sepsis progressing to septic shock.Results The levels of lactic acid,procalcitonin,total bilirubin,and direct bilirubin in the shock group were higher than those in the non-shock group(all P<0.05).The incidence of acute renal insufficiency and mortality in the shock group were higher than those in the non-shock group[25.0%(10/40)vs 8.3%(5/60),22.5%(9/40)vs 3.3%(2/60),both P<0.05].Univariate Logistic regression analysis showed that procalcitonin,blood lactic acid,total bilirubin,and direct bilirubin were all risk factors for BLA complicated with sepsis progressing to septic shock(all P<0.05).Conclusions The levels of procalcitonin,blood lactic acid,total bilirubin,and direct bilirubin are risk factors for BLA complicated with sepsis progressing to septic shock,which are related to the prognoses of patients.Monitoring the changes of their levels is of great significance for clinicians to make treatment decisions and judge the prognoses.