热射病患者合并感染的临床特征及危险因素分析

Analysis of clinical features and risk factors of heat stroke patients with infection

目的研究热射病(heat stroke,HS)患者合并感染的临床特征及危险因素。方法回顾性分析2020-07-01至2022-09-30期间就诊于四川大学华西医院、成都医学院第二附属医院等7家医院急诊科的HS患者,收集患者基本特征及实验室检查结果。依据病原学结果将患者划分为感染组与非感染组,分析不同组别之间的临床特征差异,采用多因素Logistic回归筛选变量,建立预测模型并绘制ROC曲线,比较其与SOFA评分的预测效能。结果研究期间共183例HS患者,根据纳排标准最终纳入156例进行分析,其中感染组58例(37.2%);非感染组98例(62.8%)。感染组的院内病死率显著高于非感染组(41.4%vs.25.5%,P<0.05)。与非感染组相比,感染组患者入院时血清降钙素原、结合胆红素、谷丙转氨酶(alanine transaminase,ALT)、肌酐、乳酸脱氢酶、肌酸激酶同工酶、肌红蛋白、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、需呼吸支持比率均显著更高,白蛋白水平更低(均P<0.05)。多因素Logistic回归分析显示入院时肌红蛋白、ALT、APTT和需呼吸支持是HS合并感染的独立危险因素,基于该四项指标构建预测模型,预测模型ROC曲线下面积为0.846,优于SOFA评分(0.732,P<0.05)。结论HS患者合并感染显著增加院内病死率。入院时的肌红蛋白、ALT、APTT以及需呼吸支持是HS合并感染的危险因素,基于此四项指标构建的预测模型,对于早期识别热射病合并感染的效能优于SOFA评分。

Objective To investigate the clinical features and risk factors of infection in patients with heat stroke(HS).Methods The patients with HS who were admitted to the emergency departments of seven hospitals,including West China Hospital of Sichuan University,the Second Affiliated Hospital of Chengdu Medical College and so on,between July 01,2020 and September 30,2022 were retrospectively analyzed.The basic characteristics and laboratory test results of the patients were collected.The patients were divided into infected group and non-infected group according to the etiological results,and the differences in clinical characteristics between the different groups were compared.Multivariate logistic regression was used to screen variables,and the predictive model was established and ROC curve was performed to compare the predictive efficiency with SOFA score.Results During the study period,a total of 183 patients with HS were included,and 156 patients were finally included for analysis according to the inclusion and exclusion criteria.Among them,58 cases(37.2%)were in the infected group.The mortality of infected group was significantly higher than that of non-infected group(41.4%vs.25.5%,P<0.05).Compared with the patients in noninfected group,the infected gourp serum procalcitonin,direct bilirubin,alanine transaminase(ALT),creatinine,lactate dehydrogenase(LDH),creatine kinase isoenzymes,myoglobin,activated partial thromboplastin time(APTT)and respiratory support ratio at admission were significantly higher and albumin level was lower in infected group(all P<0.05).Multivariate logistic regression analysis showed that myoglobin,ALT,APTT and respiratory support required at admission were independent risk factors for HS co-infection.A prediction model was constructed based on these four indicators,and the area under ROC curve of the prediction model was 0.846,which was better than SOFA score(0.732,P<0.05).Conclusions The prognosis of patients with heat stroke complicated with infection were obviously poor.Myoglobin,ALT,APTT and need for respiratory support at admission are risk factors for HS complicated with infection.The prediction model based on these four indicators is better than SOFA score for the early identification of the HS patients with infection.