经急诊医学科首诊并住院脓毒性脑病患者死亡风险因素分析:单中心回顾性研究

目的:单中心回顾性分析经急诊医学科首诊并住院脓毒性脑病（SAE）患者死亡风险因素。方法:按照SAE诊断标准选取2016年1月1日—2020年12月31日经天津医科大学总医院急诊医学科首诊并住院的897例SAE患者为调查对象，将患者分为死亡组和生存组，对患者基本和临床资料进行回顾性分析，并采用单因素和多因素Logistic回归分析探讨影响SAE患者死亡的风险因素。结果:急诊医学科首诊的SAE构成比无时间规律性。897例经急诊医学科首诊并住院的SAE患者中死亡组238例，病死率为26.53%。经单因素分析显示:两组患者吸烟史、饮酒史、合并疾病（高血压、糖尿病和高脂血症）、白细胞计数、C反应蛋白和降钙素原差异无统计学意义（均P>0.05）；死亡组男性比例、年龄、序贯器官衰竭估计评分（SOFA）、改良早期预警评分（MEWS）、急性生理与慢性健康评分（APACHE）-Ⅱ均高于生存组，差异有统计学意义（P<0.05）。经多因素Logistic回归分析显示:男性、年龄＞68岁、SOFA＞7分、MEWS＞6分、APACHE-Ⅱ＞15分是经急诊医学科首诊并住院的SAE患者死亡的独立危险因素。结论:SAE在急诊医学科就诊患者中的构成比无时间规律性。68岁以上男性、SOFA评分＞7分、MEWS评分＞6分、APACHE-Ⅱ评分＞15分的经急诊医学科首诊并住院SAE患者发生死亡的风险较高。

Analysis of risk factors of death in patients with septic encephalopathy first diagnosed and hospitalized in emergency medical department: a single center retrospective study

Objective: To retrospectively analyze the risk factors of death in patients with sepsis associated encephalopathy（SAE） who were first diagnosed and hospitalized in the department of emergency Tianjin. Methods: According to the diagnostic criteria of SAE，897 patients with SAE who were first diagnosed and hospitalized by the department of emergency in the General Hospital of Tianjin Medical University from January 1，2016 to December 31，2020 were selected as the survey objects. The patients were divided into death group and survival group. The basic data，basic and clinical data of the patients were analyzed retrospectively，and the risk factors affecting the death of patients with SAE were discussed by univariate analysis and multivariate Logistic regression analysis. Results: There was no time regularity in the composition ratio of SAE in the first visit of the department of emergency. Among 897 patients with SAE，238 patients died in the death group，and the case fatality rate was 26.53%. Univariate analysis showed that there was no significant difference in smoking history，drinking history，combined disease（hypertension，diabetes and hyperlipidemia），white blood cell（WBC） count，C reactive protein（CRP） and procalcitonin（PCT） between the two groups（all P>0.05）. The proportion of men，age，sequential organ failure assessment（SOFA），modified early warning score（MEWS），acute physiology and chronic health evaluation（APACHE）-Ⅱ in the death group were significantly higher than those in the survival group（P<0.05）. Multivariate Logistic regression analysis showed that male，age > 68 years old，SOFA> 7 points，MEWS> 6 points and APACHE-Ⅱ> 15 points were independent risk factors for death of patients with SAE first diagnosed and hospitalized by the department of emergency. Conclusion: The constituent ratio of SAE in the department of emergency is irregular. Men over 68 years old with SOFA score> 7，mews score> 6 and APACHE-Ⅱ score> 15 have a higher risk of death in patients with SAE first diagnosed by the department of emergency and hospitalized.