重症败血症患者炎性介质水平对预后的影响

探索可早期预测败血症预后的炎性介质指标。方法：前瞻性研究,观察期28日,分析重症败血症患者与死亡相关的临床和实验室指标。结果：共连续观察26例,死亡14例（53．8％）,且多死于研究阶段的第1周内（74．0％）。死亡组患者血总胆红素水平、4项全身炎性反应综合征（SIRS）指标的积分和循环中的细胞间黏附分子－1（sICAM-1)水平明显高于死亡组,其它炎性因子包括一些细胞因子和黏附分子的水平在2组间差异不大。结论：败血症患者的sICAM-1水平可早期预测脏器衰竭和死亡。     

新生儿败血症死亡相关因素分析

目的探讨新生儿败血症死亡的相关因素。方法回顾性分析商丘市中医院新生儿重症监护室2005年1月至2010年12月收治的106例诊断为新生儿败血症病例的临床资料。比较存活和死亡患儿的临床特点并进行单因素χ2检验。结果 106例患儿中,存活94例,死亡12例,总病死率11.3%;并应用统计学方法对胎龄等6项因素对本病死亡的影响做出分析,结果显示,胎龄、入院体质量、凝血功能、休克并多脏器损害、白细胞计数对本病死亡有显著影响。结论凝血功能、休克并多脏器损害等5项因素与新生儿败血症死亡显著相关。     

马尔尼菲青霉菌引起败血症致患者死亡一例

马尔尼菲青霉菌主要分布于中国南方地区及东南亚各国 ,在东南亚引起的临床感染仅次于结核分枝杆菌和新生隐球菌 ,居第三位 ,是引起艾滋病 (AIDS)患者感染的主要致病菌。该菌常从血液、骨髓以及皮肤活检组织中分离出 ,我们从 1例真菌血症患者的血液及骨髓中分离出 1株马尔尼菲青霉菌。一、病例资料患者 ,男 ,30岁 ,已婚 ,农民。主因发热 4d ,血便 9d ,于2 0 0 3年 2月 2 3日以“发热原因待查”收入我院消化内科病房。住院前 4 0d ,患者出现发热、畏寒、咽痛。在家口服抗感冒药 8d ,输液 5d(具体用药及剂量不详 ) ,症状无好转。来我院就诊前…     

紫色色杆菌导致败血症死亡1例报道

紫色色杆菌为色杆菌属，属条件致病菌，毒力较强，传染人类病例较少见。若细菌进入血液导致休克，可在短时间致命。我们从1例临床诊断为败血症的患者血液中分离到此菌。     

老年患者大肠埃希杆菌败血症死亡7例报告

我院急诊科1988～1995年共收治了7例大肠埃希杆菌性败血症,其中5例死于感染性休克和急性肾功能衰竭,2例死于多脏器功能衰竭。全部病例血培养证实有大肠埃希杆菌生长。大肠埃希杆菌感染的发病率近年来在发达国家呈上升趋势,国内也有病例报道。而有关大肠埃希杆菌所致的败血症报道较少,一旦发病,病死率极高,应引起足够的重视。1 临床资料1.1 一般资料 年龄50～70岁,男5例,女2例。既往有胆囊炎病史5例,有肺气肿病史2例。症状和体征;发热?例,黄疽5例,腹泻5例,呼吸困难7例,休克7例,急性肾功能衰竭5例,     

危重病人腹泻危险性评估方法及应用

[目的]探讨“危重病人腹泻危险性评估表”在重症监护病房（Icu）病人中应用的可行性。[方法]选择ICU病人（无原发胃肠道疾病）399例，应用“危重病人腹泻危险性评估表”进行动态评估，并根据评分进行分组，观察记录病人腹泻发生情况。[结果]危险性评分大于20分的病人腹泻发生率高。[结论]应早期对危重病人腹泻危险性进行评估，对评分大于20分的病人提早采取综合护理干预措施，以达到降低腹泻发生率、减少并发症的目的。     

危重病人腹泻危险性评估方法及应用

[目的]探讨“危重病人腹泻危险性评估表”在重症监护病房(ICU)病人中应用的可行性。[方法]选择ICU病人(无原发胃肠道疾病)399例,应用“危重病人腹泻危险性评估表”进行动态评估,并根据评分进行分组,观察记录病人腹泻发生情况。[结果]危险性评分大于20分的病人腹泻发生率高。[结论]应早期对危重病人腹泻危险性进行评估,对评分大于20分的病人提早采取综合护理干预措施,以达到降低腹泻发生率、减少并发症的目的。     

新生儿败血症124例临床分析

目的 分析新生儿败血症发病特点,展示新生儿败血症病原菌在当地的菌种特点及菌株耐药情况,提供地方性病例资料.方法 收集2017年5月至2020年5月期间福建省霞浦县医院收治的124例新生儿败血症患儿的临床资料.其中早发败血症(early-onset sepsis,EOS)患儿共49例(EOS组),晚发败血症(late-onset sepsis,LOS)患儿共75例(LOS组).比较两组患儿的性别、胎龄、出生体重、首发临床表现、血液检查结果、病原菌及转归情况.结果 EOS组早产儿19例(38.8％)较LOS组[57例(76.0％)]少(Z=﹣3.020,P=0.003);EOS组患儿出生体重正常者32例(65.3％)较LOS组[27例(36.0％)]多(Z=﹣3.040,P=0.002);EOS组患儿胎膜早破19例(38.8％)较LOS组[5例(6.7％)]多(χ2=19.576,P<0.05),两组差异均有统计学意义.败血症患儿的首发临床表现以病理性黄疸、发热及呼吸系统异常多见,EOS组以病理性黄疸首发患儿比例61.2％(30/49)较LOS组42.7％(32/75)高,组间比较差异有统计学意义(χ2=4.083,P=0.043).EOS组白细胞异常增多患儿27例(55.1％)比LOS组[19例(25.3％)]多,差异有统计学意义(χ2=11.255,P=0.001).EOS组患儿C-反应蛋白(C-reactive protein,CRP)增高患儿18例(36.7％)比LOS组[11例(14.7％)]多,差异有统计学意义(χ2=8.055,P=0.005).两组患儿血液样本中培养出革兰氏阳性菌较多[EOS组15例(12.1％)、LOS组28例(22.5％)],EOS组患儿44例、LOS组患儿73例治愈或好转.结论 新生儿败血症发病类型与患儿胎龄、体重及胎膜早破情况有关,EOS患儿以病理性黄疸为首发的临床表现概率大且白细胞增多、CRP增高的概率也比较大.     

急诊脓毒症死亡风险评分、降钙素原对脓毒血症预后评估的价值

目的:探讨急诊脓毒症死亡风险(MEDS)评分、血清降钙素原(PCT)对脓毒血症预后评估的临床意义。方法:102例脓毒血症患者按预后分为存活组和死亡组,比较治疗早期MEDS评分、PCT及急性生理与慢性健康状况(APACHEⅡ)评分,并建立ROC曲线观察三者对预后评估的临床价值。结果:两组MEDS评分、PCT和APACHEⅡ评分均有明显差异,且MEDS评分、PCT与APACHEⅡ评分存在明显相关;MEDS评分和PCT预测死亡的ROC曲线下面积分别为0.85和0.78,MEDS的敏感性和特异性分别为80.6%和86.7%,PCT的敏感性和特异性分别为82.3%和78.4%,MEDS评分对脓毒血症预后的评估特异性优于PCT、敏感性逊于PCT;两种联合应用敏感性及特异性更高(86.3%、89.9%)。结论:MEDS评分和PCT对脓毒血症患者预后有较好的预测作用,联合使用可提高敏感性及特异性。     

Severe Sepsis in Do-not-resuscitate Patients: Intervention and Mortality Rates

Background

Severe sepsis is a high-mortality disease, and early resuscitation decreases mortality. Do-not-resuscitate (DNR) status may influence physician decisions beyond cardiopulmonary resuscitation, but this has not been investigated in sepsis.

Objective

Among Emergency Department (ED) severe sepsis patients, define the incidence of DNR status, prevalence of central venous catheter placement, and vasopressor administration (invasive measures), and mortality.

Methods

Retrospective observational cohort of consecutive severe sepsis patients to single ED in 2009–2010. Charts abstracted for DNR status on presentation, demographics, vitals, Sequential Organ Failure Assessment (SOFA) score, inpatient and 60-day mortality, and discharge disposition. Primary outcomes were mortality, discharge to skilled nursing facility (SNF), and invasive measure compliance. Chi-squared test was used for univariate association of DNR status and outcome variables; multivariate logistic regression analyses for outcome variables controlling for age, gender, SOFA score, and DNR status.

Results

In 376 severe sepsis patients, 50 (13.3%) had DNR status. DNR patients were older (79.2 vs 60.3 years, p < 0.001) and trended toward higher SOFA scores (7 vs. 6, p = 0.07). DNR inpatient and 60-day mortalities were higher (50.5% vs. 19.6%, 95% confidence interval [CI] 15.9–44.9%; 64.0% vs. 24.9%, 95% CI 25.1–53.3%, respectively), and remained higher in multivariate logistic regression analysis (odds ratio [OR] 3.01, 95% CI 1.48–6.17; OR 3.80, 95% CI 1.88–7.69, respectively). The groups had similar rates of discharge to SNF, and in persistently hypotensive patients (n = 326) had similar rates of invasive measures in univariate and multivariate analyses (OR 1.19, 95% CI 0.45–3.15).

Conclusion

In this sample, 13.3% of severe sepsis patients had DNR status, and 50% of DNR patients survived to hospital discharge. DNR patients received invasive measures at a rate similar to patients without DNR status.     

外科手术后全身性炎性反应综合征和严重脓毒症患者血浆血管加压素浓度及其相关因素分析

目的：研究外科手术后全身性炎性反应综合征（SIRS）、严重脓毒症患者血浆血管加压素（AVP）浓度的变化,及其与动脉血气、血电解质、血流动力学参数的关系。方法：将2009年3月—2010年3月间收入外科监护病房（SICU）的患者,依据收入SICU24h内临床过程分为对照组、SIRS组、严重脓毒症组3组,每组10例。分别记录各组人口统计学资料、临床信息,测定动脉血气,入SICU24h内血浆AVP浓度及相应的血流动力学指标、中心静脉压、血生物化学检查数据。结果：严重脓毒症组患者的血浆AVP浓度显著高于对照组和SIRS组（1 300.59±87.49pg.mL-1比266.33±12.03pg.mL-1,397.59±18.32pg.mL-1）（P〈0.001）。血浆AVP浓度与对照组患者血Na＋值、Ca2＋值呈正相关（r=0.742,P=0.014;r=0.821,P=0.004）,仅与SIRS组患者血Na＋值呈正相关（r=0.727,P=0.017）,而与严重脓毒症组患者血Na＋值、Ca2＋值无相关（r=0.409,P=0.241）。血浆AVP浓度与严重脓毒症组患者平均动脉压（MAP）呈正相关（r=0.544,P=0.015）,与心率（HR）呈负相关（r=-0.706,P=0.023）,而与对照组及SIRS组患者的MAP及HR均无相关性（r=0.363,P=0.302;r=0.454,P=0.188）。结论：对照组与SIRS组患者血浆AVP浓度变化与血Na＋变化相关,而在严重脓毒症患者中AVP浓度仅与MAP相关,提示血流动力学的不稳定刺激了血浆AVP的分泌而发挥升压作用。     

新型感染标志物在脓毒症早期诊断中的应用及研究进展

脓毒症(sepsis)是感染引起宿主反应失调,导致危及生命的器官功能障碍症候群,病情危急,死亡率高.血培养是诊断的金标准,但培养及鉴定时间较长,而临床治疗需要在脓毒症早期杀灭病原菌以控制患者病情,提高治愈率,减少用药时间,降低死亡率.因此,迫切需要能够快速、准确诊断早期脓毒症的实验室指标以指导临床抗生素治疗.血清炎性介...     

恶性血液病菌血症患者凝血功能紊乱及其与感染炎性因子的相关性研究

本研究旨在探讨恶性血液病（急性早幼粒白血病除外）菌血症患者血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）,凝血酶时间（TT）,血浆纤维蛋白原（FIB）、抗凝血酶Ⅲ（ATⅢ）以及D二聚体（D-D）与感染相关炎性指标降钙素原（PCT）、C反应蛋白（CRP）、白介素-6（IL-6）、血清淀粉样蛋白A（SAA）的相关关系及其临床意义.回顾性分析四川大学华西医院2011年3月至2013年4月确诊为恶性血液病伴发热的2062例住院患者,按照严格的纳入排除标准选取326例,根据血培养结果分为非菌血症组（n=176）,非菌血症低蛋白组（n=78）和菌血症组（n=72）,分别记录PT、APTT、FIB、TT、ATⅢ、D-D、Plt、PCT、CRP、IL-6、SAA水平和分析数据.结果表明,菌血症组血浆凝血时间中位PT水平、中位APTT水平、中位D-D水平、中位Plt水平高于非菌血症组,炎性因子中位PCT水平、中位CRP水平、中位IL-6水平、中位SAA水平均高于非菌血症组,差异具有统计学意义（P＜0.05）.菌血症组中位ATⅢ的水平低于非菌血症组,差异具有统计学意义（P＜0.05）.两组间血浆TT、FIB水平差异无统计学意义（P＞0.05）.非菌血症组与非菌血症低蛋白组比较,各项指标差异均无统计学意义（P＞0.05）.相关性分析结果显示,炎性因子PCT水平与APTT、D-二聚体呈正相关,（P＜0.05）,与AT-Ⅲ呈负相关（P＜0.05）.结论：恶性血液病菌血症患者全身炎症反应与凝血反应有密不可分的关系,菌血症组炎症反应水平明显高于非菌血症组,同时伴有凝血功能障碍.     

The Weekend Effect for Patients with Sepsis Presenting to the Emergency Department

Background

Mortality differences in weekend and weekday admissions have been observed for a variety of conditions that require aggressive early intervention. It is unknown if there is a mortality difference that exists for patients presenting to the Emergency Department (ED) with sepsis on the weekend.

Study Objectives

We hypothesized that there is an increase in early inpatient mortality (death on day 1 or day 2 of hospitalization) among patients with sepsis who present to the ED on the weekend vs. weekdays.

Methods

We performed a cross-sectional analysis of 114,611 ED admissions with a principal diagnosis consistent with sepsis from 576 hospitals in the 2008 Nationwide Inpatient Sample. Adjusted analyses controlled for patient and hospital characteristics, and examined the likelihood of either early (day 1 or day 2 of hospitalization) or overall inpatient mortality.

Results

A greater proportion of patients admitted on the weekend died on day 1 and day 2 of hospitalization (5.4% vs. 4.0%, p < 0.001; and 7.5% vs. 6.9%, p = 0.001), the difference for overall inpatient mortality was not significant (17.9% vs. 17.5%, p = 0.08). The risk-adjusted odds ratio (OR) of day 1 and day 2 early inpatient mortality of weekend vs. weekday admissions was 1.10 (95% confidence interval [CI] 1.04–1.17) and 1.08 (95% CI 1.03–1.14), respectively; the association with overall inpatient mortality was not significant (OR 1.03, 95% CI 1.00–1.07).

Conclusions

Patients admitted through the ED with sepsis on the weekend had a greater likelihood of early mortality, but not overall mortality, when compared to patients admitted on weekdays.     

Severe Sepsis in the Emergency Department and Its Association with a Complicated Clinical Course

Abstract. Objective Infection severity as determined by clinical criteria has been recently classified and studied in hospitalized inpatients. The objective of the study was to use modified criteria to determine the clinical course associated with three levels of infection severity in infected patients admitted from the ED. Methods: This was a retrospective cohort study involving all patients 18 years of age and older admitted through the ED of an urban teaching hospital during a four-month period whose primary reason for requiring hospitalization was an infection that was recognized in the ED. ED records were reviewed for criteria used to classify patients by three levels of infection severity: no systemic inflammatory response syndrome, sepsis, and severe sepsis (SS). The relationships between these classifications as well as certain clinical characteristics and any complicated clinical course as measured by death and/or admission to an intensive care unit (ICU), and/or prolonged hospitalization, were analyzed. Results: Of 408 patients entered into the study, 138 (33.8%) fulfilled the criteria of SS in the ED. Patients with SS in the ED had a mortality of only 4.3%, though with an increased risk of dying compared with that of the other groups combined [relative risk (RR) = 11.64, 95% confidence interval (CI) = 1.43 to 96.53], an increased risk of ICU stay (RR = 7.65, 95% CI = 4.08 to 14.36), and an increased risk of prolonged hospitalization (RR = 1.99, 95% CI = 1.38 to 2.88). Although age over 60 years and several comorbid conditions also were identified by univariate analysis as risk factors, multivariate analysis revealed that only SS and diabetes mellitus (DM) were independent predictors of a complicated course. In the authors' institution, the positive predictive value (PPV) of SS for complicated clinical course was 0.48 and the negative predictive value (NPV) of no SS for no complicated course was 0.77. The PPV of [SS + DM] was 0.83, and the NPV of [SS, DM, or both] was also 0.83. Conclusion: Although the strongest correlate of a complicated clinical course identified in the ED is SS as defined by the study criteria, its specificity and PPV are low. The mortality of ED patients with SS is much lower than the mortality rates reported for inpatients with SS. SS as defined by the study criteria is too sensitive and therefore lacks utility in the ED setting.     

Clinical and Demographic Parameters of Patients Treated Using a Sepsis Protocol

PurposeThe purpose of this study was to investigate potential differences by sex in the demographic and clinical characteristics of patients treated utilizing a sepsis electronic bundle order set. Risk factors for in-hospital mortality were also assessed.MethodsData on patients in whom the sepsis order set was initiated in the emergency department over a 16-month period were entered into the hospital database. Data were analyzed for differences by sex in demographic and clinical factors, treatment modalities, and in-hospital mortality. The Bonferroni correction was applied to account for multiple comparisons; α was set at 0.006 for sex differences.FindingsA total of 2204 patients were included. Male and female cohorts were similar with regard to a variety of demographic and clinical factors, including age, Emergency Severity Index (ESI) levels 1 and 2, time to disposition, appropriateness of antibiotics, and total fluids given by weight. The ESI is an assessment score ranging from 1 to 5 (1 is emergent). There were modest differences in the source of infection (genitourinary was 4% more common in women; P = 0.03) and mode of arrival (men were 4% more likely to arrive by ambulance; P = 0.03). These differences did not achieve our predefined α of 0.006 when the Bonferroni correction was applied. Factors associated with in-hospital mortality were advanced age, arrival by ambulance, and an ESI level of 1 or 2 (all, P < 0.01).ImplicationsWomen were more likely to have a genitourinary cause of sepsis and less likely to arrive by ambulance. Risk factors of in-hospital mortality were older age, arrival by ambulance, and an ESI level of 1 or 2, but not sex.