Predictors of Acute Hemodynamic Decompensation in Early Sepsis: An Observational Study.
Predictors of Acute Hemodynamic Decompensation in Early Sepsis: An Observational Study.
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早期脓毒症急性血流动力学失代偿的预测因素：一项观察性研究。
DOI：
10.14740/jocmr2597w
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Nolan A
中科院分区：
文献类型：
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作者：
Lee YI;Smith RL;Gartshteyn Y;Kwon S;Caraher EJ;Nolan A
脓毒症的研究受到其异质性时间进程和演变的阻碍。一个亚组的严重脓毒症患者在开始治疗后不久发生休克，而其他患者则出现水肿。我们试图确定脓毒症治疗开始后低血压的发生率，并描述其临床特征和病程。对城市退伍军人事务医院入院24小时内（2011 - 2012年）符合脓毒性休克定义的所有脓毒症患者（n = 542）的电子病历进行了回顾性审查。受试者1）初始血压正常（INT），24小时内发生低血压，或2）初始低血压（IH）。采用Logistic回归分析INT/IH的相关因素。62例患者（11%）发生INT，平均初始血压为120/71 mm Hg，并发展为低血压至79/48 mm Hg。在52名患者（10%）中确定了IH，平均血压为81/46 mm Hg。INT显示交感神经张力增加，心率、血压和体温显著升高。与IH患者相比，INT患者更年轻，更频繁地使用α-受体阻滞剂，更可能因肺炎而感染。INT和IH患者在抗生素开始时间、24小时液体复苏量、血管加压药使用、器官功能障碍和28天死亡率方面相似。使用α-受体阻滞剂、白种人和体温较高是INT的独立预测因素。INT是脓毒性休克的一种独特表现，其特征是在早期治疗期间迅速恶化。通过进一步研究这一亚组，可以确定感染性休克的介质，阐明病理生理学，并提供及时的靶向治疗。
The study of sepsis is hindered by its heterogeneous time course and evolution. A subgroup of patients with severe sepsis develops shock soon after the initiation of treatment while others present hypotensive. We sought to determine the incidence of hypotension after the initiation of treatment for sepsis, and characterize their clinical features and course. A retrospective review of electronic medical record of all septic patients (n = 542) that met the definition of septic shock within 24 hours of admission (2011 - 2012) at an urban Veteran Affairs Hospital was performed. Subjects either had 1) initial normotension (INT) with hypotension developing within 24 hours or 2) initial hypotension (IH). Logistic regression was used to model associated factors of INT/IH. INT occurred in 62 patients (11%) with average initial blood pressure of 120/71 mm Hg and developed hypotension to 79/48 mm Hg. IH was identified in 52 patients (10%) with average presenting blood pressure of 81/46 mm Hg. INT showed evidence of increased sympathetic tone with significantly higher heart rate, blood pressure and temperature. INT patients were younger, more frequently on alpha-blockers, and more likely septic from pneumonia compared to IH patients. INT and IH patients had similar timing of antibiotic initiation, amount of 24-hour fluid resuscitation, vasopressor use, organ dysfunction and mortality at 28 days. Using alpha-blockers, being Caucasian, and having higher temperatures were independent predictors of INT. INT is a distinctive presentation of septic shock characterized by rapid deterioration during early treatment. By further studying this subgroup, mediators of septic shock may be identified that clarify pathophysiology and provide timely targeted treatment.