Disease progression in hemodynamically stable patients presenting to the emergency department with sepsis.
Disease progression in hemodynamically stable patients presenting to the emergency department with sepsis.
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DOI：
10.1111/j.1553-2712.2010.00664.x
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发表时间：
2010-04
期刊：
影响因子：
--
通讯作者：
Rivers EP
中科院分区：
文献类型：
--
作者：
Glickman SW;Cairns CB;Otero RM;Woods CW;Tsalik EL;Langley RJ;van Velkinburgh JC;Park LP;Glickman LT;Fowler VG Jr;Kingsmore SF;Rivers EP
积极的诊断和治疗感染性休克的急诊科（艾德）患者已被证明可以降低死亡率。为了提高对病情较轻的患者进行干预的能力，需要更好地了解从简单感染到更严重疾病的早期进展的自然史。目的是：1）描述艾德脓毒症的临床表现，包括感染类型和致病微生物，2）确定感染艾德患者早期进展为脓毒性休克相关的发病率、患者特征和死亡率。这是一项多中心研究，研究对象为患有脓毒症但无休克证据的成人艾德患者。采用多变量logistic回归分析确定早期进展为休克的患者因素及其与30天死亡率的相关性。472例在艾德就诊时未发生休克的患者（收缩压> 90 mm Hg，乳酸< 4 mmol / L）中，84例（17.8%）在72小时内进展为休克。与早期进展为休克相关的独立因素包括年龄较大、女性、体温过高、贫血、合并肺部疾病和血管通路装置感染。早期进展为休克（与无进展相比）与30天死亡率较高相关（13.1%与3.1%，比值比[OR] = 4.72，95%置信区间[CI] = 2.01至11.1; p ≤ 0.001）。在379例无并发症脓毒症患者中（即，无休克或任何终末器官功能障碍的证据），86例（22.7%）在入院后72小时内进展为严重脓毒症或休克。严重程度较轻的脓毒症艾德患者中有相当一部分在72小时内进展为严重脓毒症或休克。需要额外的诊断方法来进行风险分层，并更有效地治疗脓毒症艾德患者。
Aggressive diagnosis and treatment of patients presenting to the emergency department (ED) with septic shock has been shown to reduce mortality. To enhance the ability to intervene in patients with lesser illness severity, a better understanding of the natural history of the early progression from simple infection to more severe illness is needed. The objectives were to 1) describe the clinical presentation of ED sepsis, including types of infection and causative microorganisms, and 2) determine the incidence, patient characteristics, and mortality associated with early progression to septic shock among ED patients with infection. This was a multicenter study of adult ED patients with sepsis but no evidence of shock. Multivariable logistic regression was used to identify patient factors for early progression to shock and its association with 30-day mortality. Of 472 patients not in shock at ED presentation (systolic blood pressure > 90 mm Hg and lactate < 4 mmol / L), 84 (17.8%) progressed to shock within 72 hours. Independent factors associated with early progression to shock included older age, female sex, hyperthermia, anemia, comorbid lung disease, and vascular access device infection. Early progression to shock (vs. no progression) was associated with higher 30-day mortality (13.1% vs. 3.1%, odds ratio [OR] = 4.72, 95% confidence interval [CI] = 2.01 to 11.1; p ≤ 0.001). Among 379 patients with uncomplicated sepsis (i.e., no evidence of shock or any end-organ dysfunction), 86 (22.7%) progressed to severe sepsis or shock within 72 hours of hospital admission. A significant portion of ED patients with less severe sepsis progress to severe sepsis or shock within 72 hours. Additional diagnostic approaches are needed to risk stratify and more effectively treat ED patients with sepsis.
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影响因子：
158.5
作者：
Rivers, E;Nguyen, B;Tomlanovich, M
通讯作者：
Tomlanovich, M
DOI：
10.1097/01.asn.0000074237.78764.d1
发表时间：
2003-07-01
影响因子：
13.6
作者：
Allon, M;Depner, TA;Schwab, SJ
通讯作者：
Schwab, SJ
影响因子：
8.8
作者：
Shapiro, Nathan I.;Trzeciak, Stephen;Rivers, Emanuel P.
通讯作者：
Rivers, Emanuel P.
影响因子：
4.3
作者：
Carre, Jane E.;Singer, Mervyn
通讯作者：
Singer, Mervyn
影响因子：
9.6
作者：
Adrie, Christophe;Azoulay, Elie;Timsit, Jean Francois
通讯作者：
Timsit, Jean Francois