细菌培养阴性和培养阳性的脓毒症患者的临床特点和结局对比  

Bacteria-negative and bacteria-positive sepsis:a comparison of characteristics and outcomes

作　　者：邹志业 文琼 熊丽红[1] ZOU Zhiye;WEN Qiong;XIONG Lihong(Department of Critical Care Medicine,Shenzhen Second People's Hospital,the First Affiliated Hospital of Shenzhen University,Shenzhen,Guangdong,518035,China;Department of Rehabilitation,Nan'ao People's Hospital,Dapeng New Area,Shenzhen)

机构地区：[1]深圳市第二人民医院(深圳大学第一附属医院)重症医学科,广东深圳518035 [2]深圳市大鹏新区南澳人民医院康复科

出　　处：《临床急诊杂志》2021年第12期796-801,共6页Journal of Clinical Emergency

基　　金：深圳市第二人民医院高水平医院医疗质控及提升项目(No:202104029);深圳市第二人民医院临床科研项目(No:20193357003,20203357014);深圳市医疗“三名工程”项目(No:SZSM20162011);广东省高水平临床重点专科(深圳市配套建设经费资助)(No:SZGSP006)。

摘　　要：目的:比较细菌培养阴性和培养阳性的脓毒症患者的临床特点和结局。方法:数据从MIMIC-Ⅲ及eICU-CRD两个公开的重症医学数据库中提取,筛选入重症监护病房(ICU)的成年脓毒症患者。根据入ICU前后48h的细菌培养结果分为两组:细菌培养阴性组和细菌培养阳性组。分析细菌培养阴性对脓毒症患者90d病死率的影响,并比较两组患者的临床特征、疾病严重程度、住院时间及住院病死率之间的差异。结果:MIMIC-Ⅲ符合纳入标准的患者共9642例,其中细菌培养阴性患者共5491例,细菌培养阳性患者共4151例。两组患者的年龄、性别、总住院时间及第1天行血液净化的比例(4.4%vs.5.2%)均差异无统计学意义(P>0.05);细菌培养阴性组患者的WBC_(max)、Lac_(max)、T_(max)、SOFA评分(5.26±2.93vs.5.60±3.16)、ECI共病指数、SAPSⅡ评分、ICU住院时间[3.07(1.73,6.97)d vs.3.26(1.83,7.32)d]、第1天行机械通气比例(45.3%vs.47.4%)、住院病死率(14.7%vs.16.3%)及90d病死率(19.7%vs.22.6%)均较阳性组低,差异有统计学意义(P<0.05)。多因素分析可见,糖尿病、血流感染、泌尿系统感染、WBC_(max)及T_(max)为细菌培养阳性的危险因素(P<0.05)。单因素分析可见,细菌培养阳性(OR=1.13,95%CI:1.01~1.26,P=0.029)、年龄、ECI指数、SAPSⅡ评分及SOFA评分均为90d病死的危险因素,但在调整协变量后,细菌培养阳性对90d病死率无影响(OR=1.01,95%CI:0.89~1.13,P=0.920)。生存曲线见细菌培养阴性组与阳性组患者的预后差异无统计学意义。从eICU-CRD提取出588例符合纳入排除标准且信息完整的脓毒症患者,其中细菌阴性组159例,阳性组429例。两组间年龄及性别差异无统计学意义。与细菌培养阳性组相比,细菌培养阴性组患者的ICU住院时间及总住院时间较短,APACHEⅣ评分较低(66.10±27.40vs.75.76±29.36),差异有统计学意义(P<0.05)。虽然细菌培养阴性组的住院病死率较低(5.7%vs.10.5%),但两组Objective:To compare the clinical characteristics and outcomes of patients with bacteria-negative and culture-positive sepsis.Methods:Data were extracted from two public intensive care medicine databases,MIMIC-Ⅲand eICU-CRD and adult sepsis patients were screened in ICU.According to the bacterial culture results within 48hbefore and after admission to ICU,they were divided into bacteria-negative and bacteria-positive groups.The impact of bacteria-negative on the 90-day mortality of patients with sepsis was analyzed,and the difference in clinical characteristics,disease severity,length of stay,and inpatient mortality were compared between the two groups.Results:A total of 9642patients met the inclusion criteria in MIMIC-Ⅲ,including 5491 patients with bacteria-negative cultures and 4151patients with bacteria-positive cultures.There was no significant difference in age,gender,the total length of hospital stay,and the proportion of blood purification performed on the first day(4.4%vs.5.2%)between the two groups(P>0.05).Bacteria-negative patients'WBC_(max),Lac_(max),T_(max),SOFA score(5.26±2.93vs.5.60±3.16),Elixhauser Comorbidity Index,SAPSⅡscore,length of stay in ICU[3.07(1.73,6.97)d vs.3.26(1.83,7.32)d],mechanical ventilation rate on the first day(45.3%vs.47.4%),in-hospital mortality rate(14.7%vs.16.3%)and 90-day mortality rate(19.7%vs.22.6%)were lower than bacteria-positive patients,showing significant differences(P<0.05).Multivariate analysis showed that diabetes,bloodstream infection,urinary system infection,WBC_(max),and T_(max)were risk factors for positive bacterial culture(P<0.05).Univariate analysis showed that bacteria-positive culture(OR=1.13,95%CI:1.01-1.26,P=0.029),age,ECI index,SAPSⅡscore,and SOFA score were risk factors for 90-day mortality.After adjusting covariates,bacteria-positive patients had no effect on 90-day mortality(OR=1.01,95%CI:0.89-1.13,P=0.920).The survival curve showed no significant difference in the prognosis of the two groups of patients.A total of 588patients with sepsis w

关 键 词：脓毒症 细菌培养 病死率 

分 类 号：R459.7[医药卫生—急诊医学]