2022 年第 8 期 第 17 卷

急诊老年血流感染患者死亡危险因素分析

Analysis of death risk factors in elderly patients with bloodstream in emergency department

作者：皮春梅刘妍崔北辰马丽平刘志伟王聪

英文作者：Pi Chunmei Liu Yan Cui Beichen Ma Liping Liu Zhiwei Wang Cong

单位：北京积水潭医院回龙观院区急诊科，北京100096

英文单位：Department of Emergency Huilongguan Branch of Beijing Jishuitan Hospital Beijing 100096 China

关键词：血流感染；脓毒性休克；危险因素

英文关键词：Bloodstreaminfection;Septicshock;Riskfactors

• 摘要：

• 目的 探讨急诊老年血流感染患者死亡的危险因素。方法 回顾性分析2019年1月至2020年1月北京积水潭医院急诊科收治的年龄≥65岁的血流感染患者103例的临床资料。根据患者入院后28 d预后情况分为生存组（72例）和死亡组（31例），比较2组患者的临床资料，采用Logistic回归方法分析患者死亡的危险因素。结果 单因素分析结果显示，死亡组患者的降钙素原、C反应蛋白、白细胞计数、心肌肌钙蛋白I、血肌酐、血尿素氮水平和吸入氧浓度、急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、Pitt菌血症评分（PBS）、序贯器官衰竭估计（SOFA）评分、Charlson合并症指数（CCI）评分均高于生存组患者，平均动脉压、血气分析pH值、格拉斯哥昏迷量表（GCS）评分均低于生存组患者（均P＜0.05）。死亡组患者存在脓毒性休克、应用血管活性药物比例明显高于生存组患者（均P＜0.05）。多因素Logistic回归分析结果显示，合并脓毒性休克、GCS评分、APACHE Ⅱ评分、PBS、SOFA评分、CCI评分是影响急诊老年血流感染患者死亡的独立危险因素（比值比=5.557、0.865、2.321、1.421、1.537、1.549，95%置信区间：1.358～22.745、0.764～0.979、1.036～5.332、1.210～1.874、1.237～2.464、1.192～2.011，P=0.017、0.022、0.001、0.002、0.001、0.001）。结论 脓毒性休克、GCS评分、APACHEⅡ评分、PBS、SOFA评分、CCI评分是急诊老年血流感染患者死亡的独立危险因素。

• Objective To investigate the risk factors of death in elderly patients with bloodstream infection in emergency department. Methods The clinical data of 103 patients with bloodstream infection aged ≥ 65 years old in Department of Emergency, Beijing Jishuitan Hospital from January 2019 to January 2020 were retrospectively analyzed. According to the prognosis of 28 d after admission, the patients were divided into survival group (72 cases) and death group (31 cases). The clinical data of the two groups were compared, and the risk factors of death were analyzed by Logistic regression method. Results The single factor analysis showed that levels of procalcitonin, C-reactive protein, white blood cell count, cardiac troponin I, serum creatinine, blood urea nitrogen, inhaled oxygen concentration, acute physiology and chronic health evaluation system Ⅱ(APACHE) score, Pitt bacteremia score(PBS), sequential organ failure assessment(SOFA) score, and Charlson comorbidity index(CCI) score in the death group were significantly higher than those in the survival group, and mean arterial pressure, pH value of blood gas analysis and Glasgow Coma Scale(GCS) score were significantly lower than those in the survival group (all P＜0.05). The proportions of septic shock and using vasoactive drugs in the death group were significantly higher than those in the survival group (both P＜0.05). Multivariate Logistic regression analysis showed that combined septic shock, GCS score,  APACHE Ⅱ score, PBS, SOFA score and CCI score were independent risk factors affecting the prognosis of elderly patients with bloodstream infection in emergency department (odds ratio=5.557, 0.865, 2.321, 1.421, 1.537, 1.549, 95% confidence interval： 1.358-22.745, 0.764-0.979, 1.036-5.332, 1.210-1.874, 1.237-2.464, 1.192-2.011，P=0.017, 0.022, 0.001, 0.002, 0.001, 0.001). Conclusion Septic shock, GCS score, APACHE Ⅱ score, PBS, SOFA score and CCI score are independent risk factors affecting the prognosis of elderly patients with bloodstream infection in emergency department.