急诊科尿路感染进展为尿源性脓毒症的危险因素分析  

Analysis of risk factors for the progression of urinary tract infection to urosepsis in emergency department

作　　者：宋昆[1] 丁宁[1] 石国民[2] 杨志伟[1] 李长罗[1] SONG Kun;DING Ning;SHI Guomin;YANG Zhiwei;LI Changluo(Department of Emergency,Changsha Central Hospital,Changsha,410004,China;Departmentof Laboratory,Changsha Central Hospital)

机构地区：[1]长沙市中心医院急诊医学科,长沙410004 [2]长沙市中心医院检验科

出　　处：《临床急诊杂志》2020年第8期629-633,共5页Journal of Clinical Emergency

基　　金：湖南省卫生计生委课题(No:B20180468)。

摘　　要：目的:探讨尿路感染进展为尿源性脓毒症的危险因素,为急诊医生早期识别高位患者提供参考依据。方法:选取2018-01—2019-12期间我院急诊医学科收治住院的82例尿路感染进展为尿源性脓毒症的患者为观察组,与同时期收治的尿路感染无脓毒症的79例患者为对照组,比较2组患者的临床特征及炎症指标,分析尿路感染进展为尿源性脓毒症可能的危险因素。结果:观察组与对照组在年龄、性别、血小板(PLT)、淋巴细胞(LYM)、中性淋巴比(NLR)、降钙素原(PCT)之间的差异具有统计学意义;在是否存在泌尿系梗阻、既往泌尿系手术史、糖尿病、慢性肾脏疾病、白细胞(WBC)、中性粒细胞(NEU)、C-反应蛋白(CRP)之间差异无统计学意义。PCT、NLR的ROC曲线下面积分别为0.763、0.688,PCT较NLR对尿路感染是否进展为尿源性脓毒症具有较好的预测价值。二元Logistic回归分析结果显示年龄(P=0.000,回归系数0.041)、PCT(P=0.010,回归系数0.015)是急诊科尿路感染是否进展为尿源性脓毒症的独立危险因素。以PCT=1.835为参考值,判断尿路感染进展为尿源性脓毒症的敏感度为72.0%,特异度为72.2%。结论:PCT对尿路感染进展为尿源性脓毒症有较好的预测价值,年龄、PCT是尿路感染进展为尿源性脓毒症独立的危险因素。Objective: To investigate the risk factors for the progression of urinary tract infection to urosepsis, and provide reference for emergency physicians to early identify patients with high risk of urosepsis. Method: From January 2018 to December 2019, 82 patients in the emergency department of Changsha Central Hospital were enrolled as the observation group, and 79 patients in the same period were enrolled as the control group. The clinical characteristics and inflammatory indexes of the patients in the two groups were compared, and the possible risk factors for the progression of urinary tract infection to urosepsis were analyzed. Result: There were significant differences in age, gender, PLT, lymphocyte, NLR, PCT between the observation group and the control group. There were no significant differences in the presence of urinary obstruction, urological operation medical history, diabetes, chronic kidney disease, white blood count(WBC), neutrophil(NEU), and C-response protein(CRP). The area under ROC curve of PCT and NLR was 0.763 and 0.688, respectively. PCT was a better indicator for predicting the progression of urinary tract infection to urosepsis than NLR. The results of binary logistic regression analysis showed that the P value of age and PCT was 0.000 and 0.010 respectively, while the regression coefficient of age and PCT was 0.041 and 0.015 respectively. Age and PCT both were independent risk factors for the progression of urinary tract infection to urosepsis in emergency department. Based on PCT=1.835, the sensitivity and specificity of predicting value were 72.0% and 72.2%, respectively. Conclusion: PCT had a good predictive value for the progression of urinary tract infection to urosepsis. Age and PCT both were independent risk factors for the progression of urinary tract infection to urosepsis.

关 键 词：尿路感染 尿源性脓毒症 炎性指标 降钙素原 

分 类 号：R541[医药卫生—心血管疾病]