严重脓毒症/脓毒症休克患者预后的高危因素

目的分析严重脓毒症/脓毒症休克患者的临床资料、致病菌分布及生化指标情况，探讨影响危重脓毒症患者预后的高危因素。 方法选择我院2004年12月至2014年12月收治的1 013例严重脓毒症/脓毒症休克患者作为研究对象，记录患者一般资料、生理学和慢性健康状况评分Ⅱ(APACHE Ⅱ)、感染部位及致病菌、生化指标等，根据预后情况分为存活组562例和死亡组451例，采用logistic回归分析影响患者预后的独立危险因素。 结果死亡组患者与存活组相比，年龄(59.62±11.21 vs. 46.32±9.46)岁、APACHE Ⅱ评分(25.26±8.75 vs. 13.67±6.57)、脓毒症休克所占比率(54.99% vs. 27.22%)均明显增加(P<0.05)，存活组患者的血清白蛋白与血小板计数水平明显高于死亡组患者(P<0.05)，降钙素原与血乳酸水平明显低于死亡组患者，差异均具有统计学意义(P<0.05)。2组患者呼吸系统感染比例(35.05% vs. 36.59%)与G^-菌感染比例(46.44% vs. 63.64%)最高，患者年龄、APACHEⅡ评分、血乳酸、降钙素原与危重脓毒症患者的预后呈负相关关系(r＝-0.359、-0.876、-0.582、-0.821，P<0.05)，血清白蛋白与危重脓毒症患者的预后呈正相关关系(r＝0.637，P<0.05)。年龄+APACHEⅡ+血乳酸+血降钙素原+血清白蛋白联合检测对严重脓毒症/脓毒症休克患者死亡具有更高的预测价值(AUC＝0.981)。 结论年龄、APACHEⅡ评分、血乳酸、降钙素原及血清白蛋白是影响严重脓毒症/脓毒症休克患者预后的独立危险因素，对早期预测和有效改善严重脓毒症/脓毒症休克患者预后具有具有重要的临床。

Logistic regression analysis of the pathogens infection and prognosis in patients with severe sepsis/septic shock

ObjectiveTo explore the high risk factors affecting the prognosis of patients with severe sepsis or septic shock by analyzing the clinical data, the distribution of pathogenic bacteria and other biochemical indicators of these patients. MethodsA total of 1 013 patients with severe sepsis/septic shock admitted to our hospital from December 2004 to December 2014 were selected as the research objects. General data, physiological and chronic health score Ⅱ (APACHE Ⅱ), infection site, pathogenic bacteria and biochemical indicators were recorded. According to the prognosis, the patients were divided into survival group 562 cases and death group 451 cases. Logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of the patients. ResultsCompared with the survival group, the age(59.62±11.21 vs. 46.32±9.46) , APACHEⅡ score (25.26±8.75 vs. 13.67±6.57) and the proportion of septic shock (54.99% vs. 27.22%)of the patients in the death group increased significantly (P<0.05). The levels of serum albumin and platelet count of the patients in the survival group were significantly higher than that in the death group (P<0.05), and the levels of procalcitonin and blood lactic acid were significantly lower than that in the death group (P<0.05). Respiratory infection rate (35.05% vs. 36.59%) and G-bacteria infection rate (46.44% vs. 63.64%) were the highest in the second group. Age, APACHEⅡ score, blood lactic acid, and procalcitonin were negatively correlated with the prognosis of patients with severe sepsis (r=0.359, -0.876, -0.582, -0.821, P<0.05). Serum albumin was positively correlated with the prognosis of patients with severe sepsis (r=0.637, P<0.05). Age+ APACHEⅡ+ blood lactic acid+ procalcitonin+ serum albumin combined detection has higher predictive value for death of severe sepsis/septic shock patients (AUC=0.981). ConclusionAge, APACHEⅡ score, serum lactic acid, procalcitonin and serum albumin are independent risk factors affecting the prognosis of patients with severe sepsis/septic shock, which have important clinical value for early prediction and effective improvement of the prognosis of patients with severe sepsis/septic shock.