老年念珠菌血症所致感染性休克患者预后因素分析

    Analysis of Related Factors on Septic Shock Caused by Candidemia among Elderly Critically Ill Patients

    • 摘要: 目的 研究老年念珠菌血症所致感染性休克患者的相关因素,探讨判断疗效和预后的指标。 方法 回顾性分析广东省老年医学研究所ICU 31例经血培养确诊念珠菌血症所致感染性休克患者(非中性粒细胞减少或缺乏)的临床资料,根据28天预后分为生存组和死亡组,观察两组患者第1、2、3、5和7天血降钙素原、C-反应蛋白、白细胞计数、血乳酸、序贯器官衰竭估计评分(SOFA)和急性生理与慢性健康状况系统Ⅱ评分(APACHE Ⅱ评分)等指标的动态变化,并对两组患者的相关资料进行统计学分析。 结果 死亡组16例,生存组15例;血培养结果以非白色念珠菌居多(71%)、白色念珠菌占29%;两组患者第1天 APACHE Ⅱ评分和第1天血降钙素原差异有统计学意义。死亡组APACHE Ⅱ评分高于生存组(27.63±5.14)vs. (22.60±5.88),P=0.017;生存组第1天血降钙素原(2.74±2.32)ng/mL较死亡组(1.45±1.01)ng/mL高(P=0.045);两组血降钙素原水平均随时间而变化 (P<0.05)且两组变化趋势的差异有统计学意义(P<0.05),变化曲线显示生存组第3天血降钙素原到达高峰(4.27±5.19)ng/mL、其后逐渐下降,而死亡组呈逐渐上升趋势(P=0.004)。Logistic回归分析显示,第1天血降钙素原和APACHE Ⅱ评分是影响28天预后的独立危险因素,分别为比值比=0.272(95%可信区间 0.084~0.883,P=0.030) 和比值比=1.349(95%可信区间1.052~1.731,P=0.018)。两组白细胞计数、C-反应蛋白、血乳酸和SOFA评分在各时间点的变化趋势差异无统计学意义。 结论 老年念珠菌血症所致感染性休克患者(非中性粒细胞减少或缺乏),应早期选用覆盖非白色念珠菌的药物;血降钙素原水平和APACHE Ⅱ评分值是影响28天预后的独立危险因素;对相关指标的动态观察评估临床意义更大。

       

      Abstract: Objective To investigate related factors for prognosis in elderly critically ill patients with septic shock caused by candidemia. Methods Single center, retrospective and observational study, thirty-one non-neutropenic elderly septic shock patients caused by candidemia in intensive care unit (ICU) were enrolled. Levels of procalcitonin (PCT), C-reactive protein (CRP), white blood cell (WBC) count, blood lactic acid (LAC), sequential organ failure assessment (SOFA) score as well as acute physiology and chronic health evaluationⅡ (APACHEⅡ) score on 1st, 2nd, 3rd, 5th, 7th day after making a definite of diagnosis of septic shock caused by candidemia were collected. Patients were divided into survival group and death group according to 28-day mortality. Differences in parameters between two group were compared, and multiple logistic regression analysis was performed to identify the risk factors significantly associated with 28-day mortality. Results During the study period (January 2010 to December 2014), 31 septic shock patients caused by candidemia episodes in ICU were enrolled, of whom 71% were identified as non-albicans candida and 29% were candida albicans. There were 16 patients in death group and 15 patients in survival group. APACHEⅡscore in death group was significantly higher than those in survival group at first day(27.63±5.14)vs. (22.60±5.88),P=0.017, and PCT in survival group was significantly higher than those in death group (2.74±2.32) vs. (1.45±1.01),P=0.045. PCT and APACHEⅡ score decreased in survival group with time dependency pattern after 3rd day. In addition, the results of effect analysis showed that there were significant differences in PCT and APACHEⅡ score between both groups (P<0.05). WBC, CRP, LAC, as well as SOFA score did not change significantly in both groups, and there were no significantly differences at each time point between both groups. Multivariable logistic regression analysis revealed that PCT (odds ratio 0.272, 95%CI 0.084~0.883, P=0.030) and APACHEⅡscore (odds ratio 1.349, 95%CI 1.052~1.731,P=0.018) were independently associated with 28-day mortality between two groups. Conclusion Antifungal agents sensitive to non-albicans candida should be a priority to those elderly non-neutropenic septic shock patients caused by candidemia in ICU; PCT and APACHEⅡscores are independently associated with 28-day mortality for those patients; and greater clinical significance could be attained with dynamic observation and evaluation of both parameters.

       

    /

    返回文章
    返回