Analysis of prognostic risk factors in patients with sepsis caused by enterobacteriaceae bloodstream infection / 中华急诊医学杂志

ABSTRACT

Objective:To study the prognostic risk factors of Enterobacteriaceae bloodstream infection in patients with sepsis.Methods:The medical records of patients with sepsis caused by Enterobacteriaceae bloodstream infection in our hospital from June 2017 to May 2019 were screened. The gender, age, admission department, basic disease, infection site, etiology examination and treatment plan were recorded in detail. The survival and death groups were divided according to the patient's survival status. The ratio of C-reactive protein (CRP) to serum prealbumin (PA) was recorded within 24 h after admission. The acute physiological and chronic health scores (APACHEⅡ score) and Pitt bacteremia score (PBS score) were calculated within 24 h, and based on the results of blood culture drug sensitivity test to analyze whether the initial experience treatment was appropriate. Logistic regression analysis was used to analyze the risk factors affecting the prognosis of patients, and the receiver operating characteristic curve (ROC curve) was drawn to predict the occurrence of poor prognosis in patients with sepsis.Results:Logistic regression analysis showed that CRP ( OR=1.021, P<0.01), CRP/PA ( OR=34.638, P<0.01), extended-spectrum β-lactamase production ( OR=0.244, P<0.01), inappropriate empirical antibacterial treatment ( OR=0.156, P<0.01), APACHE Ⅱ score ( OR=1.436, P<0.01), and PBS score ( OR=8.622, P<0.01) were risk factors affecting patient's prognosis. Multivariate regression analysis showed that CRP/PA ( OR=25.420, P<0.05), inappropriate empirical treatment ( OR=0.077, P<0.05), APACHEⅡ score ( OR=1.476, P<0.01), PBS score ( OR=12.042, P<0.01) were independent risk factors for death in patients with sepsis ( P<0.05). The higher the CRP/PA level, PBS score and APACHEⅡ score, the worse the prognosis. When CRP/PA ≥0.89, PBS score ≥3.5, APACHEⅡ score ≥17.5, the patient's risk of death increased significantly. In addition, inappropriate empirical treatment was also a key factor in patients with poor prognosis. Conclusions:CRP/PA, PBS score, APACHE Ⅱ score, and inappropriate empiricaltreatment are independent risk factors affecting the prognosis of patients with enterobacter hemorrhagic infection with sepsis. The PBS score and APACHEⅡ score can better predict the poor prognosis and risk of death. Compared with APACHEⅡscore, the former is simpler and practical and can be widely used.