重症监护病房老年脓毒症患者的临床特征及预后影响因素分析

Analysis on the clinical characteristics and prognostic factors in the elderly patients with sepsis in intensive care unit

目的 探讨重症监护病房(ICU)老年脓毒症患者的临床特征及预后影响因素,为降低老年脓毒症患者病死率提供临床参考。方法 回顾性选取2021年1月至2022年12月联勤保障部队第九四医院收治的95例老年脓毒症患者,根据入住ICU后28 d存活情况分为存活组(48例)和死亡组(47例),比较两组临床特征的差异,应用多因素logistic回归模型分析老年脓毒症患者预后的影响因素。结果 Logistic回归分析显示合并多脏器功能障碍(MODS)和脓毒性休克、急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分高是影响老年脓毒症患者28 d预后的独立危险因素(OR=6.309、12.001、4.768、P<0.05),氧合指数高是保护因素(OR=0.176,P<0.01)。氧合指数、MODS、脓毒性休克和APACHEⅡ评分预测老年脓毒症患者预后不良的ROC曲线下面积分别为0.790、0.875、0.614和0.736。结论 低氧合指数、合并MODS和脓毒性休克以及高APACHEⅡ评分是影响ICU老年脓毒症患者预后的独立危险因素,对其预后具有较好的预测价值。

Objective To investigate the clinical characteristics and prognostic factors affecting elderly patients with sepsis in intensive care unit(ICU)and provide clinical reference for reducing mortality of elderly patients with sepsis.Methods A total of 95 elderly patients with sepsis admitted to the 940 Hospital of Joint Logistic Support Force of PLA from January 2021 to December 2022 were retrospectively selected.The patients were divided into survival group(48 patients)and death group(47 patients)according to their survival status 28 days after admission to ICU.The differences of clinical features between the two groups were compared,and the prognostic factors of elderly patients with sepsis were analyzed by a multivariate logistic regression model.Results Logistic regression analysis showed that low oxygenation index,multiple organ dysfunction(MODS)and septic shock,and high acute physiological and chronic health evaluationⅡ(APACHEⅡ)scores were independent risk factors for 28-day prognosis in elderly patients with sepsis(OR=6.309,12.001,4.768,P<0.05),and high oxygenation index was a protective factor(OR=0.176,P<0.01).The area under ROC curve for oxygenation index,MODS,septic shock and APACHEⅡscores to predict poor prognosis in elderly septic patients were 0.790,0.875,0.614 and 0.736,respectively.Conclusion Low oxygenation index,complicated with MODS and septic shock,and high APACHEⅡscore are independent risk factors affecting the prognosis of elderly septic patients in ICU,and have good predictive value for their prognosis.