院内二次感染对肝硬化患者死亡风险水平的影响

目的: 探讨肝硬化患者的死亡率与二次感染之间的关系,阐明二次感染对肝硬化患者死亡风险水平的影响。方法: 共纳入103例肝硬化患者,分为初次感染组(78例)和二次感染组(25例),比较2组患者的基本特征、终末期肝病模型(MELD)评分、血清白蛋白水平、感染的微生物和30 d 内的死亡率等,分析各部位感染发生率的变化,并通过多因素Logistic回归模型分析肝硬化患者死亡的危险因素。结果: 与初次感染组比较,二次感染组患者死亡率明显增加(P<0.05),肺炎和艰难梭状芽孢杆菌相关性肠炎(CDAD)的发生率明显增加(P<0.05)。多因素Logistic回归模型分析,发生二次感染(OR=4.582,P=0.000 2)、高MELD评分(OR=1.293,P<0.000 1)和低血清白蛋白(OR＝0.487,P=0.0387)是肝硬化患者死亡的独立危险因素。 结论: 院内二次感染能显著增加肝硬化患者死亡风险水平。

Influence of second infection in risk of death of hospitalized patients with cirrhosis

Objective To investigate the relationship between the second infection and the mortality of the patients with cirrhosis, and to elucidate the influence of the second infection in the risk of death of the patients with cirrhosis. Methods A total of 103 patients with cirrhosis were enrolled and divided into first infection group (n=78) and second infection group (n=25).The basic characteristics,model for end-stage liver disease (MELD) scores,serum albumin levels,microorganisms and mortality rates in 30 d as well as the incidence of infection in parts of body of the patients in two groups were compared,and the risk factors for death in the patients with cirrhosis were analyzed by multivariate Logistic regression model. Results The mortality of the patients in second infection group was significantly higher than that in first infection group (P<0.05).The incidence of pneumonia and clostridium difficile-associated diarrhea (CDAD) of the patients in second infection group was significantly increased compared with first infection group (P<0.05).Logistic regression analysis illustrated that the higher MELD scores (OR=1.293,P<0.0001),existence of second infection (OR=4.582,P=0.0002) and lower serum albumin level (OR=0.487,P=0.0387) were the independent risk factors for the death in patients with cirrhosis. Conclusion Second infection independently increase the risk of death of the hospitalized patients with cirrhosis.