IMPACT OF ENCEPHALOPATHY ON MORTALITY IN THE SEPSIS SYNDROME
IMPACT OF ENCEPHALOPATHY ON MORTALITY IN THE SEPSIS SYNDROME
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DOI：
10.1097/00003246-199008000-00001
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发表时间：
1990-08-01
影响因子：
8.8
通讯作者：
HINSHAW, LB
中科院分区：
文献类型：
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作者：
SPRUNG, CL;PEDUZZI, PN;HINSHAW, LB
脓毒症是医院死亡的一个重要原因，仍然是诊断和治疗的挑战。为了更清楚地确定脑病对脓毒症病程的影响，我们检查了脓毒症的各种临床症状、血培养结果和死亡率与脓毒症患者精神状态的关系。患者被分类为因脓毒症而导致精神状态急剧改变（AAMS）、先前存在的精神状态改变（PAMS）或正常精神状态（NMS）。 百分之二十三 (307/1333) 的研究患者因脓毒症而出现感觉中枢的急剧改变。 AAMS 患者的死亡率 (49%) 高于 PAMS 患者 (41%) 或 NMS 患者 (26%) (p < .000001)。多变量分析显示，精神状态改变、体温过低、低血压、血小板减少和不发冷是脓毒症综合征死亡率增加的独立预测因素。革兰氏阴性菌血症患者 (28%) 与革兰氏阳性菌血症患者 (25%) 或血培养阴性患者 (23%) 患有 AAMS 的可能性相同。总之，精神状态的改变在脓毒症患者中很常见，并且与显着较高的死亡率相关。
Sepsis, an important cause of hospital mortality, continues to be a diagnostic and therapeutic challenge. To define more clearly the impact of encephalopathy on the course of sepis, the various clinical signs of sepsis, blood culture results, and mortality rates were examined in relation to mental status in septic patients. Patients were classified as having an acutely altered mental status due to sepsis (AAMS), preexisting altered mental status (PAMS), or normal mental status (NMS). Twenty-three (307/1333) percent of the study patients had an acutely altered sensorium secondary to sepsis. Patients with AAMS had a higher mortality (49%) than patients with PAMS (41%) or patients with NMS (26%) (p < .000001). Multivariate analysis disclosed that altered mental status, hypothermia, hypotension, thrombocytopenia, and the absence of shaking chills were independent predictors of increased mortality in the sepsis syndrome. Patients with Gram-negative bacteremia (28%) were as likely to have AAMS as patients with Gram-positive bacteremia (25%) or patients with negative blood cultures (23%). In summary, alterations in mental status are common in septic patients, and are associated with significantly higher mortality.