血流感染患者死亡危险因素和血清白蛋白及感染部位对预后预测的临床研究  

Clinical study on the risk factors of mortality and the association of serum albumin and infection site with the prognosis in patients with bloodstream infection

作　　者：杨志伟 宋昆 丁宁 李长罗 赫留党 周世方 徐术根 刘跃华[2] YANG Zhiwei;SONG Kun;DING Ning;LI Changluo;HE Liudang;ZHOU Shifang;XU Shugen;LIU Yuehua(Department of Emergency Medicine,Changsha Central Hospital,Hengyang Medical College,University of South China,Changsha,410004,China;Clinical Nursing Teaching and Research Section,the Second Xiangya Hospital,Central South University)

机构地区：[1]南华大学衡阳医学院附属长沙中心医院急诊医学科,长沙410004 [2]中南大学湘雅二医院临床护理学教研室

出　　处：《临床急诊杂志》2023年第9期464-469,共6页Journal of Clinical Emergency

基　　金：湖南省卫生计生委科研项目(No:B20180468,20201088)。

摘　　要：目的:探讨血流感染患者28d死亡危险因素和血清白蛋白及感染部位对预后的预测价值。方法:回顾分析南华大学附属长沙中心医院282例血培养阳性血流感染患者临床资料,根据28d生存情况分为生存组(241例)和死亡组(41例),比较两组临床资料,然后将差异有统计学意义的项目进行单因素和多因素logistic回归分析,并以多因素分析有统计学意义的血清白蛋白、感染部位及二者联合构建预测模型,绘制ROC曲线,用ROC曲线评估血流感染28d死亡风险的预测价值。结果:282例血培养阳性血流感染患者中,革兰阴性菌为主,占比为59.9%,革兰阳性菌占比为39.0%;革兰阴性菌以大肠埃希菌(36.5%)和肺炎克雷伯氏菌(12.0%)为主,革兰阳性菌以凝固酶阴性葡萄球菌(12.8%)和金黄色葡萄糖球菌(9.2%)为主;28d生存组和死亡组在性别、病原体分类、感染部位、血尿素氮、血肌酐和白蛋白方面比较,差异有统计学意义(P<0.05);年龄、糖尿病史、血糖、白细胞、中性粒细胞、淋巴细胞、血小板计数、红细胞压积、PCT分级、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素和住院时间≥30d比较,差异无统计学意义(P>0.05);感染部位中泌尿系统、呼吸系统、消化管道、肝胆系统、导管相关、神经系统、骨关节及皮肤软组织分别为34.8%、34.4%、6.4%、9.6%、5.0%、2.8%和4.3%;多因素分析中感染部位和白蛋白与28d死亡预后相关(P<0.05);感染部位以泌尿系统为参照,呼吸系统、消化管道、神经系统和骨关节及皮肤软组织28d病死率分别为泌尿系统的9.5倍,7.8倍,21.8倍和9.0倍,差异有统计学意义(P<0.05);以血清白蛋白、感染部位及二者联合预测28d死亡,绘制ROC曲线,AUC分别为0.612(95%CI:0.515~0.710)、0.661(95%CI:0.583~0.738)和0.719(95%CI:0.644~0.795)。结论:血清低白蛋白血症和感染部位是血流感染患者28d死亡风险的独立危险因素,相对于泌尿系统,�Objective:To explore risk factors of 28-day mortality in patients with bloodstream infection,and the predictive value of serum albumin and infection site for prognosis.Methods:A retrospective analysis was conducted on the clinical data of 282patients with blood culture positive bloodstream infection in The Affiliated Changsha Central Hospital University South China.They were divided into a 28-day survival group(n=241)and a 28-day non-survival group(n=41).The clinical data of the two groups were compared,and statistically significances were analyzed by univariate and multivariate logistic regression analysis.A predictive model was constructed with serum albumin,infection site,and a combination of both.ROC curves were performed to evaluate the predictive value for 28-day mortality risk in patient with bloodstream infection.Results:Among the 282bloodstream infection patients with positive blood cultures.Gram-negative bacteria accounted for 59.9%,while Gram-positive bacteria accounted for 39.0%;Gram-negative bacteria were mainly Escherichia coli(36.5%)and Klebsiella pneumoniae(12.0%),while Gram-positive bacteria were mainly coagulase negative Staphylococcus(12.8%)and Staphylococcus aureus(9.2%).There were statistically significant differences(P<0.05)between the survival group and the death group in terms of gender,pathogen classification,infection site,blood urea nitrogen,blood creatinine,albumin.There were no statistical significances(P>0.05)in age,history of diabetes,blood sugar,white blood cells,neutrophils,lymphocytes,platelet count,hematocrit,PCT grade,alanine transaminase,glutamic transaminase,total bilirubin direct bilirubin and hospitalization time≥30days between 28-day survival group and 28-day non-survival group.The urinary system,respiratory system,gastrointestinal tract,hepatobiliary system,catheter-related,nervous system,and musculoskeletal and soft tissue accounted for 34.8%,34.4%,6.4%,9.6%,5.0%,2.8%,and 4.3%respectively in terms of the site of infection.The infection site and albumin were associated

关 键 词：血流感染 脓毒症 白蛋白 感染部位 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]