肺炎克雷伯菌肝脓肿致脓毒症的临床特征及危险因素分析  

Retrospective Analysis of Clinical Features and Risk Factors for Sepsis Due to Liver Abscess Caused by Klebsiella Pneumoniae

作　　者：刘江福[1] 何秀华[1] 陈泰裕 杨鹏雅[1] 赵芳芳 林志鹏[1] 林孟新[1] 郭如意[1] LIU Jiangfu;HE Xiuhua;CHEN Taiyu;YANG Pengya;ZHAO Fangfang;LIN Zhipeng;LIN Mengxin;GUO Ruyi(Department of Infectious Disease,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou Fujian 362000,China;Department of Critical Care Medicine,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou Fujian 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院感染科,福建泉州362000 [2]福建医科大学附属泉州第一医院重症医学科,福建泉州362000

出　　处：《中国卫生标准管理》2022年第17期134-138,共5页China Health Standard Management

基　　金：福建医科大学启航基金项目(2020QH1273)。

摘　　要：目的肺炎克雷伯菌(Klebsiella pneumoniae,KP)是化脓性肝脓肿(pyogenic liver abscess,PLA)的最主要病原体,临床上却鲜有报道合并脓毒症的资料。本研究旨在评估KP所导致肝脓肿(Klebsiella pneumoniae-caused liver abscesses,KPLA)患者合并脓毒症的临床特征及其危险因素,以期为临床早期决策提供依据。方法这项回顾性队列研究调查了2013年1月—2020年12月在福建医科大学附属泉州第一医院住院的206例KPLA患者,分为脓毒症组及非脓毒症组,分析了人口学特征、临床特征以及实验室和影像学结果。通过多因素Logistic回归,确定KPLA致脓毒症的危险因素。结果与非脓毒症组相比,脓毒症组平均年龄更大[(64.5±13.6)岁vs.(59.8±10.3)岁,P=0.006)、住院时间明显延长[(22.6±12.3)d vs.(16.3±9.4)d,P=0.000)],更容易继发KPLA侵袭性综合征(15.7%vs.1.5%,P=0.000)、感染性休克(11.4%vs.0.7%,P=0.001)和急性肾损伤(12.9%vs.3.2%,P=0.005);多因素Logistic回归,结果显示,合并糖尿病(OR=3.46,P=0.003)、PCT>9.85 ng/mL(OR=4.65,P=0.001)、发生肝脓肿侵袭性综合征(OR=7.31,P=0.025)为KPLA致脓毒血症的危险因素。结论合并糖尿病、PCT>9.85 ng/mL、发生肝脓肿侵袭性综合征为KPLA合并脓毒症的危险因素,进展为脓毒症后,住院时间延长、并发症及病死率均增加。Objective Klebsiella pneumoniae(KP)is the predominant pathogen of pyogenic liver abscesses(PLA),but sepsis in combination with KP has rarely been reported clinically.The study aimed to evaluate the clinical features and risk factors of sepsis in patients with Klebsiella pneumoniae-caused liver abscesses(KPLA),with the aim of providing a basis for early clinical decision making.Methods This retrospective cohort study investigated 206 patients with KPLA in Quanzhou First Hospital Affiliated to Fujian Medical University from January 2013 to December 2020,divided into the sepsis group and the non-sepsis group,and analyzed demographic characteristics,clinical features,and laboratory and imaging findings.Risk factors for sepsis due to KPLA were determined by multifactorial Logistic regression.Results Compared with the non-sepsis group,the sepsis group had a greater mean age[(64.5±13.6)years old vs.(59.8±10.3)years old,P=0.006),a significantly longer hospital stay[(22.6±12.3)d vs.(16.3±9.4)d,P=0.000),was more likely to have secondary KPLA invasive syndrome(15.7%vs.1.5%,P=0.000),infectious shock(11.4%vs.0.7%,P=0.001)and acute kidney injury(12.9%vs.3.2%,P=0.005);multifactorial Logistic regression showed that diabetes mellitus(OR=3.46,P=0.003),PCT>9.85 ng/mL(OR=4.65,P=0.001),and the occurrence of hepatic abscess invasive syndrome(OR=7.31,P=0.025)were risk factors for sepsis due to KPLA.Conclusion Combined diabetes mellitus,PCT>9.85 ng/mL,and occurrence of hepatic abscess invasive syndrome were risk factors for KPLA combined with sepsis,and progression to sepsis was associated with prolonged hospital stay,increased complications,morbidity and mortality.

关 键 词：肝脓肿 肺炎克雷伯菌 脓毒症 危险因素 化脓性 糖尿病 

分 类 号：R657[医药卫生—外科学]