Clinical characteristics and risk factors associated with ICU-acquired infections in sepsis: A retrospective cohort study.
Clinical characteristics and risk factors associated with ICU-acquired infections in sepsis: A retrospective cohort study.
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DOI：
10.3389/fcimb.2022.962470
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发表时间：
2022
影响因子：
5.7
通讯作者：
中科院分区：
文献类型：
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重症监护病房（ICU）获得性感染是ICU脓毒症预后不良的常见原因。然而，脓毒症相关的icu获得性感染尚未得到充分的描述。该研究旨在评估风险因素，并建立一个预测败血症患者重症监护病房获得性感染风险的模型。我们从重症监护医学信息市场（MIMIC） IV数据库中检索数据。患者按7:3的比例随机分为训练组和验证组。采用多变量logistic回归模型确定能够预测icu获得性感染的独立危险因素。我们还评估了其识别和校准能力，并将其与经典评分系统进行了比较。在16808例脓毒症患者中，2871例（17.1%）发生重症监护病房获得性感染。ICU获得性感染患者的ICU死亡率为17.7%，住院死亡率为31.8%，入院后28天至100天死亡率持续上升。经典系统性炎症反应综合征评分（SIRS）、顺序器官衰竭评估（SOFA）、牛津急性疾病严重程度评分（OASIS）、简化急性生理评分II （SAPS II）、Logistic器官功能障碍评分（LODS）、Charlson合并症指数（CCI）和急性生理评分III （APS III）评分与ICU获得性感染、脑血管功能不全、革兰氏阴性菌、手术ICU、气管造口术、中心静脉导管、导尿管、机械通气、红细胞输入、LODS评分和抗凝治疗是脓毒症患者发生icu获得性感染的独立预测因素。基于这些独立预测因子的正态图在推导群体（AUROC = 0.737, 95% CI, 0.725-0.749）和验证群体（AUROC = 0.751, 95% CI, 0.734-0.769）中均显示出良好的校准和辨别能力，优于SIRS、SOFA、OASIS、SAPS II、LODS、CCI和APS III模型。重症监护病房获得性感染增加了脓毒性死亡的可能性。基于nomogram个体化预后模型能够准确预测icu获得性感染，优化管理或治疗方案。
Intensive care unit (ICU)-acquired infection is a common cause of poor prognosis of sepsis in the ICU. However, sepsis-associated ICU-acquired infections have not been fully characterized. The study aims to assess the risk factors and develop a model that predicts the risk of ICU-acquired infections in patients with sepsis. We retrieved data from the Medical Information Mart for Intensive Care (MIMIC) IV database. Patients were randomly divided into training and validation cohorts at a 7:3 ratio. A multivariable logistic regression model was used to identify independent risk factors that could predict ICU-acquired infection. We also assessed its discrimination and calibration abilities and compared them with classical score systems. Of 16,808 included septic patients, 2,871 (17.1%) developed ICU-acquired infection. These patients with ICU-acquired infection had a 17.7% ICU mortality and 31.8% in-hospital mortality and showed a continued rise in mortality from 28 to 100 days after ICU admission. The classical Systemic Inflammatory Response Syndrome Score (SIRS), Sequential Organ Failure Assessment (SOFA), Oxford Acute Severity of Illness Score (OASIS), Simplified Acute Physiology Score II (SAPS II), Logistic Organ Dysfunction Score (LODS), Charlson Comorbidity Index (CCI), and Acute Physiology Score III (APS III) scores were associated with ICU-acquired infection, and cerebrovascular insufficiency, Gram-negative bacteria, surgical ICU, tracheostomy, central venous catheter, urinary catheter, mechanical ventilation, red blood cell (RBC) transfusion, LODS score and anticoagulant therapy were independent predictors of developing ICU-acquired infection in septic patients. The nomogram on the basis of these independent predictors showed good calibration and discrimination in both the derivation (AUROC = 0.737; 95% CI, 0.725–0.749) and validation (AUROC = 0.751; 95% CI, 0.734–0.769) populations and was superior to that of SIRS, SOFA, OASIS, SAPS II, LODS, CCI, and APS III models. ICU-acquired infections increase the likelihood of septic mortality. The individualized prognostic model on the basis of the nomogram could accurately predict ICU-acquired infection and optimize management or tailored therapy.