Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients
Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients
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DOI：
10.1164/rccm.200208-785oc
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发表时间：
2003-07-01
影响因子：
24.7
通讯作者：
Le Gall, JR
中科院分区：
文献类型：
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作者：
Alberti, C;Brun-Buisson, C;Le Gall, JR
感染患者全身炎症反应的临床意义尚不清楚。我们研究了欧洲脓毒症研究中3,608例重症监护病房患者的医院死亡率风险因素。患者被分类为患有无或有感染（即，脓毒症）全身炎症反应、严重脓毒症和脓毒性休克。根据脓毒症分期，住院死亡率从25%到60%不等，但前两类之间没有差异（危险比，0.94; p = 0.55），而严重程度从脓毒症到严重脓毒症（1.53，p < 10（-4））和脓毒性休克（2.64，p < 10（-4））有一个分级。在每个阶段内，死亡率不受炎症反应标准数量的影响。通过考克斯回归分析确定的预后因素包括共病、急性疾病和急性器官功能障碍的严重程度、休克、医院感染、需氧革兰氏阴性杆菌、肠杆菌、金黄色葡萄球菌引起的感染以及消化道或未知来源的感染。我们的结论是，而通过器官功能障碍或休克的存在对感染进行分类具有很强的预后意义，感染和脓毒症具有相似的结果，不受炎症反应标准的存在或数量的影响。需要对出现感染且无器官功能障碍的患者进行风险分层。
The clinical significance of the systemic inflammatory response in infected patients remains unclear. We examined risk factors for hospital mortality in 3,608 intensive care unit patients included in the European Sepsis Study. Patients were categorized as having infection without or with (i.e., sepsis) systemic inflammatory response, severe sepsis, and septic shock, on the first day of infection. Hospital mortality varied from 25 to 60% according to sepsis stage, but did not differ between the first two categories (hazard ratio, 0.94; p = 0.55), whereas there was a grading of severity from sepsis to severe sepsis (1.53, p < 10(-4)) and septic shock (2.64, p < 10(-4)). Within each stage, mortality was unaffected by the number of inflammatory response criteria. Prognostic factors identified by Cox regression included comorbid conditions, severity of acute illness and acute organ dysfunction, shock, nosocomial infection, and infection caused by aerobic gram-negative bacilli, enterobacteria, Staphylococcus aureus, and infection from a digestive or unknown source. We conclude that whereas the categorization of infection by the presence of organ dysfunction or shock has strong prognostic significance, infection and sepsis have similar outcomes, unaffected by the presence or number of inflammatory response criteria. Refinement of risk stratification of patients presenting with infection and no organ dysfunction is needed.