Clinical characteristics and prognosis of serous body cavity effusions in patients with sepsis: a retrospective observational study.
Clinical characteristics and prognosis of serous body cavity effusions in patients with sepsis: a retrospective observational study.
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脓毒症患者浆液性体腔积液的临床特征及预后：一项回顾性观察研究
DOI：
10.1186/s12871-018-0621-6
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发表时间：
2018-11-14
影响因子：
2.2
通讯作者：
Song ZJ
中科院分区：
文献类型：
--
作者：
Xing LY;Yin J;Shao M;Yang YL;Li KY;Xue MM;Mu SC;Sun Z;Zhang YP;Yao CL;Chu X;Tong CY;Song ZJ
背景 腔积液在感染性疾病患者中很常见。然而，脓毒症患者浆液腔积液（SCE）的发生率和特征迄今为止尚不清楚。本研究旨在调查脓毒症患者SCE的发生率和特点，探讨脓毒症患者血性渗出液与病情严重程度/预后的相关性。方法2010年1月至2015年1月，共纳入214例严重脓毒症合并脓毒性休克患者进行回顾性观察研究。 45例脓毒症患者因大量胸腔积液或腹水而进行胸腔穿刺术或腹腔穿刺术。采用酶联免疫吸附法（ELISA）检测45例脓毒症患者腹腔穿刺血清中VEGF、VEGFR、Ang、sICAM-1、sVCAM-1、E-选择素、Serpine1、VE-cadherin浓度。结果214例脓毒症患者中，根据影像学或超声表现，155例（72.4%）存在SCE。 45 名 SCE 受试者接受了治疗性胸腔穿刺术或腹腔穿刺术。积液实验室分析显示，与漏出液相比，渗出液占主导地位（95.6% vs. 4.4%），16 名患者（35.6%）出现血性积液。与非血性积液患者相比，血性积液患者的危重病评分更高（APACHE II 为 13 vs. 17；SOFA 为 7 vs. 9），死亡率也较高（6.9% vs. 62.5%）。此外，血性渗出患者的TT和APTT延迟，D-二聚体浓度升高，血清CRP和PCT水平升高（P<0.05）。此外，血性渗出患者血清Ang2、sVCAM-1和E-选择素水平显着高于非血性渗出患者（P< 0.05）。但血性液体患者血清VEGFR2水平较低（P= 0.025）。结论脓毒症患者浆膜腔积液发生率较高。与非血性渗出液的脓毒症患者相比，血性渗出液的脓毒症患者炎症负担更大，预后更差。
BackgroundCavity effusion is common in patients with infectious diseases. However, the incidence rate and characteristics of serous cavity effusions (SCE) in septic patients are not clear to date. The objective of this study was to investigate the incidence and characteristics of SCE in septic patients and to explore the correlations between the bloody effusions and the illness severity/prognosis in septic patients.MethodsFrom January 2010 to January 2015, a total of 214 patients with severe sepsis and septic shock were enrolled in this retrospective observational study. Thoracentesis or abdominal paracentesis was performed in 45 septic patients because of massive pleural effusions or ascites. The serum concentrations of VEGF, VEGFR, Ang, sICAM-1, sVCAM-1, E-selectin, Serpine1 and VE-cadherin in 45 septic patients underwent paracentesis were measured by enzyme-linked immunosorbent assay (ELISA).ResultsOf the 214 septic patients, 155 (72.4%) had SCE according to imaging or ultrasound manifestations. 45 subjects with SCE underwent therapeutic thoracentesis or abdominal paracentesis. Effusion laboratory analysis showed that exudates were predominant when compared with transudates (95.6% vs. 4.4%), and 16 (35.6%) patients suffered bloody effusions. Compared with patients with non-bloody effusions, those with bloody effusions showed higher critical illness scores (13 vs. 17 for APACHE II; 7 vs. 9 for SOFA), and higher mortality (6.9% vs. 62.5%). Moreover, patients with bloody effusions had delayed TT and APTT, increased D-dimer concentration, and higher serum levels of CRP and PCT (P< 0.05). In addition, the serum levels of Ang2, sVCAM-1 and E-selectin were significantly higher in patients with bloody effusions than in those with non-bloody effusions (P< 0.05). However, the serum level of VEGFR2 was lower in patients with bloody fluids (P= 0.025).ConclusionsThe incidence of serous cavity effusion is high in patients with sepsis. The septic patients with bloody effusions suffer a more inflammatory burden and a worse prognosis compared to septic patients with non-bloody effusions.
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影响因子：
38.9
作者：
Dellinger RP;Levy MM;Rhodes A;Annane D;Gerlach H;Opal SM;Sevransky JE;Sprung CL;Douglas IS;Jaeschke R;Osborn TM;Nunnally ME;Townsend SR;Reinhart K;Kleinpell RM;Angus DC;Deutschman CS;Machado FR;Rubenfeld GD;Webb S;Beale RJ;Vincent JL;Moreno R;Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
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