Risk factors and clinical analysis on acute hepatic dysfunction induced by sepsis / 中华急诊医学杂志

Objective To study the incidence,risk factors and clinical features of patients with acute hepatic dysfunction induced by sepsis. Methods One hundred and sixty patients with sepsis were assigned to two groups according to liver function: sepsis group and acute hepatic dysfunction group. Logistic regression analysis was used to study the risk factors.The comparison of plasma endothelin-1 ( ET-1 ) and sepsis-related organ failure assessment (SOFA) score between two groups was carried out.Results Of 160sepsis patients,25 (15.6％) patients were subjected to acute hepatic dysfunction induced by sepsis.Logistic regression analysis showed that long-term indulgence in wine drunk (OR =4.102,95％ CI 1.288 -13.063 ),history of cardiac insufficiency ( OR =4.109,95％ CI 1.352 - 12.493) and hypotension ( OR =5.833,95％ CI:1.712 - 19.868 ) were the significant risk factors.Though oxygenation index ( PaO2/FiO2),platelet (PLA) and Glasgow coma scale (GCS) were not different between two groups,the total bilirubin (Tbil),direct bilirubin (Dbil),creatitine (Cre),range of blood glucose variation (Rglu),lactic acid (Lac),plasma ET-1and SOFA score in acute hepatic dysfunction group were higher than those in sepsis group. Mortality rate in acute hepatic dysfunction group was higher than that in sepsis group.Conclusions Long-term drunk,history of cardiac insufficiency and hypotension are the risk factors in acute hepatic dysfunction induced by sepsis.Elevated arterial Lac and plasma ET-1 levels,and higher SOFA score in acute hepatic dysfunction group suggest poor prognosis.

Values of continuous renal replacement therapy in the treatment of multiple organ dysfunction syndrome induced by sepsis / 中华急诊医学杂志

Objective To study the values of continuous renal replacement therapy (CRRT) for the treatment of multiple organ dysfunction syndrome ( MODS) induced by sepsis. Methods A total of 62 patients with MODS were divided into three groups, namely non-CRRT group, short period CRRT group (24 ~ 48 h) and long period CRRT group( >48 h). Relevant factors including organ function, plasma endothelin-1 (ET-1),sepsis-related organ failure assessment(SOFA)score, average length of survival time and accumulative survival rate were analyzed . Results Compared with non-CRRT group, a statistically significant difference in SOFA score was evident on the 4th day after long period CRRT group and on the 6th day after short period CRRT group. The survival rates of three groups on the third day after treatment were 56. 3% 、 83.3% and 88.9%, respectively (P0.05). The average lengths of survival time in three groups were(4.4 ±2.6)days, (9.5 ±6. l)days and (10.3 ±5.4)days, respectively. Compared with non-CRRT group, the average lengths of survival time were longer in the other two groups. The levels of serum ET-1 significantly decreased after CRRT treatment (P<0.05). Conclusions The organ function and survival rate could be improved by CRRT. Average lengths of survival time were significantly prolonged in two CRRT groups(P <0.05). More effective therapeutic results including lower SOFA score and longer average length of survival time were observed when the course of CRRT was extended longer properly.

Risk factors and drug-resistance of Pseudomonas aeruginosa infection in intensive care unit / 中华临床感染病杂志

Objective To investigate the incidence, risk factors and drug-resistance of Pseudomonas aeruginosa infection in intensive care unit (ICU). Methods Totally 171 patients with sepsis admitted in ICU were enrolled. Pathogenic bacteria culture and antimicrobial susceptibility tests were performed. SPSS10. 0 software was used for Logistic regression analysis of the risk factors. Results Pseudomonas aeruginosa infection was confirmed in 37 patients, and 45 strains of Pseudomonas aeruginosa were isolated. Logistic regression revealed that recent antibiotics use ( OR = 4. 291 , 95% CI: 1. 727-10. 662) , length of ICU stay (OR = 1.117, 95% CI: 1.058-1. 181) , mechanical ventilation (OR = 3.400, 95% CI: 1.348-8.579) and central venous catheterization (OR =3. 339, 95% CI: 1.322-8.434) were independent risk factors of Pseudomonas aeruginosa infection. The resistance rate of cefotaxime was the highest (68.9%) and 18 strains (40%) were multidrug-resistant. Conclusions Pseudomonas aeruginosa infection is common in ICU and it is usually multidrug resistant. The rational use of antibiotics and aseptic technique of invasive catheterization are important for the prevention of Pseudomonas aeruginosa infection.