Candidemia as a cause of septic shock and multiple organ failure in nonimmunocompromised patients
Candidemia as a cause of septic shock and multiple organ failure in nonimmunocompromised patients
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DOI：
10.1097/00003246-200208000-00023
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发表时间：
2002-08-01
影响因子：
8.8
通讯作者：
Nasraway, SA
中科院分区：
文献类型：
--
作者：
Hadley, S;Lee, WW;Nasraway, SA
目的：描述由念珠菌血症引起的感染性休克和多器官功能衰竭的结局。设计：对北美感染性休克试验安慰剂组数据的二次队列分析NORASEPT II是迄今为止进行的最大的前瞻性、随机、双盲、对照的多中心感染性休克研究，并对结局进行了预定终点分析。成人重症监护病房在105家医院在美国和加拿大。主题：一个队列的10个纯念珠菌感染性休克患者与一个队列的376个纯菌血症患者感染性休克进行了比较。患者没有免疫功能低下，因为皮质类固醇，中性粒细胞减少症，或移植后的患者被排除在NORASEPT II.测量和主要结果：人口统计学变量，基线特征，28天的死亡率，多器官功能衰竭进行了比较，为两个队列。血液病患者在基线时更可能有潜在的肾衰竭病史，在感染性休克发作时更可能需要透析。感染性休克的两种原因均与极高的疾病严重程度相关（急性生理学和慢性健康评估II：念珠菌感染性休克，32 10;菌血症感染性休克，30 8; p = 0.44）。超过70%的念珠菌血症和脓毒性休克患者在第3、7和14天出现多器官衰竭;与菌血症脓毒性休克患者相比，念珠菌感染性休克患者持续存在持续性多器官衰竭，并且多器官衰竭恢复延迟。在28天的死亡率为60%，念珠菌感染性休克和46%，菌血症感染性休克（p = 0.38）。结论：败血症感染性休克是罕见的非免疫功能低下的患者，但有很高的死亡率，相关的多器官功能衰竭的可能性很高，并可能延迟恢复多器官功能衰竭。念珠菌感染性休克患者在基线时更可能有潜在的肾衰竭。
Objective: To describe outcomes of septic shock and multiple organ failure arising from candidemia.Design: Secondary cohort analysis of data from the placebo arm of the North American Septic Shock Trial (NORASEPT II), the largest prospective, randomized, double-blind, controlled multiple center study of septic shock conducted to date, with predetermined end point analysis of outcomes.Setting: Adult intensive care units in 105 hospitals in the United States and Canada.Subjects: A cohort of ten purely candidemic patients in septic shock were compared with a cohort of 376 purely bacteremic patients in septic shock. Patients were not immunocompromised, because patients on corticosteroids, with neutropenia, or post-transplantation were excluded from enrollment in NORASEPT II.Measurements and Main Results: Demographic variables, baseline characteristics, 28-day mortality rates, and multiple organ failure were compared for the two cohorts. Candidemic patients were more likely to have a history of underlying renal failure at baseline and to require dialysis at onset of septic shock. Both causes of septic shock are associated with an extremely high severity of illness (Acute Physiology and Chronic Health Evaluation II: candidemic septic shock, 32 10; bacteremic septic shock, 30 8; p = .44). More than 70% of patients with candidemia and septic shock were in multiple organ failure at days 3, 7, and 14; patients with candidemic septic shock sustained persistent multiple organ failure and showed delayed recovery from multiple organ failure compared with patients with bacteremic septic shock. Mortality rate at 28 days was 60% in candidemic septic shock and 46% in bacteremic septic shock (p = .38).Conclusions: Candidemia with septic shock is infrequent in nonimmunocompromised patients but has a very high mortality rate, a high likelihood of associated multiple organ failure, and possibly a delayed recovery from multiple organ failure. Patients with candidemic septic shock are more likely to have underlying renal failure at baseline.