Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching.
Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching.
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DOI：
10.1038/s41598-021-86346-4
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发表时间：
2021-03-26
影响因子：
4.6
通讯作者：
Linder A
中科院分区：
文献类型：
--
作者：
Mellhammar L;Kahn F;Whitlow C;Kander T;Christensson B;Linder A
人们可能错误地认为，众所周知，菌血症与脓毒症的高死亡率相关。只有少数研究专门关注培养阴性和培养阳性脓毒症的比较，根据研究设计得出不同的结论。本研究的目的是在临床回顾中描述培养阳性或阴性脓毒症危重患者的结局。我们还旨在确定败血症的亚表型，并将培养状态作为候选临床变量。在784例诊断为脓毒症并接受重症监护治疗的患者中，140例排除患者的血培养缺失，95例排除患者不符合脓毒症诊断。在纳入的549例患者中，295例（54%）有菌血症，90例（16%）为非菌血症但检测到相关病原体，164例（30%）未检测到相关病原体。校正混杂因素后，菌血症患者的90天死亡率为47%，高于非菌血症患者的36%，p = 0.04。我们确定了8个亚表型，具有不同的死亡率，其中微生物样品中的病原体检测对于亚表型的区分和结果是重要的。总之，菌血症患者的死亡率高于非菌血症患者，并且在临床综述中研究时，菌血症在脓毒症中更常见。为了减少群体异质性和改善脓毒症的试验和治疗结果，亚表型的区分可能是有用的，病原体检测是一个重要因素。
One can falsely assume that it is well known that bacteremia is associated with higher mortality in sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis with different conclusions depending on study design. The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis in a clinical review. We also aimed to identify subphenotypes of sepsis with culture status included as candidate clinical variables. Out of 784 patients treated in intensive care with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and 95 excluded patients did not fulfill a sepsis diagnosis. Of 549 included patients, 295 (54%) had bacteremia, 90 (16%) were non-bacteremic but with relevant pathogens detected and in 164 (30%) no relevant pathogen was detected. After adjusting for confounders, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p = 0.04. We identified 8 subphenotypes, with different mortality rates, where pathogen detection in microbial samples were important for subphenotype distinction and outcome. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and bacteremia is more common in sepsis when studied in a clinical review. For reducing population heterogeneity and improve the outcome of trials and treatment for sepsis, distinction of subphenotypes might be useful and pathogen detection an important factor.
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