Severe sepsis in community-acquired pneumonia - When does it happen, and do systemic inflammatory response syndrome criteria help predict course?
Severe sepsis in community-acquired pneumonia - When does it happen, and do systemic inflammatory response syndrome criteria help predict course?
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DOI：
10.1378/chest.129.4.968
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发表时间：
2006-04-01
期刊：
影响因子：
9.6
通讯作者：
Angus, DC
中科院分区：
文献类型：
--
作者：
Dremsizov, T;Clermont, G;Angus, DC
研究目的：大多数严重脓毒症的自然史研究仅限于ICU人群。我们描述了社区获得性肺炎（CAP）住院患者在住院过程中严重脓毒症的发病和时间。我们还确定了全身炎症反应综合征（SIRS）和其他在急诊科（艾德）测量的风险分层评分预测严重脓毒症、脓毒性休克或死亡的能力。设计：回顾性分析肺炎患者结局研究小组（PORT）的前瞻性观察性结局研究。1991年10月至1994年3月，美国和加拿大的四个学术医疗中心。参与者：在PORT研究队列中，1,339名因CAP住院的患者，随机选取了686名符合SIRS标准的患者。干预措施：无。测量和结果：所有受试者均有感染（CAP）。严重脓毒症被定义为新发急性器官功能障碍，在这个队列中，使用共识标准。半数患者（n = 639，48%）发生严重脓毒症，520例患者（39%）发生非肺器官功能障碍，61例受试者（4.5%）发生脓毒性休克。在艾德就诊时，分别有457名患者（71%的严重脓毒症病例）和27名患者（44%的脓毒性休克病例）出现严重脓毒症和脓毒性休克。虽然SIRS在就诊时很常见，（686例患者中82%有两个SIRS标准），但与进展为严重脓毒症的几率增加无关（两个或多个SIRS标准和三个或多个SIRS标准的比值比[OR]分别为0.65和0.89），脓毒性休克（OR，0.80和0.55）或死亡（OR，0.65和0.39），区分度较差（所有受试者操作特征[ROC]曲线下面积< 0.5）。肺炎严重程度指数与严重脓毒症相关（p < 0.001），中度区分度（ROC，0.63）。结论：严重脓毒症在住院CAP患者中常见，发生于住院早期。SIRS标准似乎不是CAP进展为严重脓毒症的有用预测因子。
Study objectives: Most natural history studies of severe sepsis are limited to ICU populations. We describe the onset and timing of severe sepsis during the hospital course for patients hospitalized with community-acquired Pneumonia (CAP). We also determine the ability of the systemic inflammatory response syndrome (SIRS) and other proposed risk stratification scores measured at emergency department (ED) presentation to predict progression to severe sepsis, septic shock, or death.Design: Retrospective analysis of a prospective observational outcome study from the Pneumonia Patient Outcomes Research Team (PORT).Setting: Four academic medical centers in the United States and Canada between October 1991 and March 1994.Participants: The 1,339 patients hospitalized for CAP in the PORT study cohort, and a random subset of 686 patients for whom we had information for SIRS criteria.Interventions: None.Measurements and results: All subjects had infection (CAP). Severe sepsis was defined as new-onset acute organ dysfunction in this cohort, using consensus criteria. Severe sepsis developed in one half of the patients (n = 639,48%), nonpulmonary organ dysfunction developed in 520 patients (39%), and septic shock developed in 61 subjects (4.5%). Severe sepsis and septic shock were present at ED presentation in 457 patients (71% of severe sepsis cases) and 27 patients (44% of septic shock cases), respectively. While SIRS was common at presentation (82% of the subset of 686 had two SIRS criteria), it was not associated with increased odds for progression to severe sepsis (odds ratios [ORs], 0.65 and 0.89 for two or more SIRS criteria and three or more SIRS criteria, respectively), septic shock (ORs, 0.80 and 0.55), or death (ORs, 0.65 and 0.39), with poor discrimination (all receiver operating characteristic [ROC] areas under the curve < 0.5). The Pneumonia severity index was associated with severe sepsis (p < 0.001) with moderate discrimination (ROC, 0.63).Conclusions: Severe sepsis is common in hospitalized CAP patients, occurring early in the hospital course. SIRS criteria do not appear to be useful predictors for progression to severe sepsis in CAP.