摘要
目的:探讨重症急性胰腺炎（SAP）继发脓毒症的高危因素，为临床早期识别和诊治提供一些临床依据。方法:回顾性分析重庆医科大学附属第一医院2013年1月至2020年12月诊断为SAP的362例患者的临床资料。根据患者是否继发脓毒症将其分为脓毒症组（157例）和非脓毒症组（205例），探讨SAP继发脓毒症的危险因素。采用单因素分析及多因素Logistic逐步回归法分析SAP继发脓毒症的独立危险因素。绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），评估各指标预测SAP继发脓毒症的效能。结果:157例SAP继发脓毒症患者中检出331株病原菌，其中细菌共258株（77.95%）。脓毒症组及非脓毒症组SAP患者白细胞计数、血小板计数、血小板/淋巴细胞比率、白蛋白、天冬氨酸氨基转移酶（AST）、肌酐、D-二聚体、降钙素原、急性病生理学和长期健康评价（APACHE）Ⅱ评分、序贯器官衰竭估计评分、住院时间、住ICU时间及机械通气时间比较，差异均有统计学意义（P均< 0.05）。多因素Logistic回归分析显示，AST[比值比（OR）= 1.004，95%置信区间（CI）（1.001，1.008），P = 0.017]、APACHEⅡ评分[OR = 1.102，95%CI（1.040，1.166），P = 0.001]、住院时间[OR = 1.017，95%CI（1.000，1.033），P = 0.042]、机械通气时间[OR = 1.080，95%CI（1.027，1.136），P = 0.003]为SAP患者继发脓毒症的独立危险因素。其AUC分别为0.678、0.723、0.596、0.726，预测的最佳截断值分别为60.5 U/L、15.5分、28.5 d、4.5 d。此外，脓毒症组患者的病死率较非脓毒症组显著升高[9.55%（15/157）vs. 2.44%（5/205），χ2 = 13.205，P = 0.001]。结论:入院时AST > 60.5 U/L、APACHEⅡ评分> 15.5分、住院时间> 28.5 d、机械通气时间> 4.5 d的SAP患者易发生脓毒症。
Abstract
Objective:To analyze risk factors of sepsis secondary to severe acute pancreatitis (SAP), and to provide lessons for its early clinical diagnosis and treatment.Methods:From January 2013 to August 2020, a total of 362 patients diagnosed with SAP at the First Affiliated Hospital of Chongqing Medical University were enrolled. The patients were divided into a sepsis group (157 cases) and a non-sepsis group (205 cases) according to whether they had secondary sepsis. Univariate analysis and multivariate Logistic regression were used to analyze independent risk factors of sepsis secondary to SAP, and receiver operating characteristic curve analysis was performed to evaluate their value in predicting SAP with sepsis.Results:A total of 331 strains of pathogenic bacteria were detected in the sepsis group, with 258 strains of bacteria (77.95%). The leucocyte count, platelet count, platelet-to-lymphocyte ratio, albumin, aspartate aminotransferase (AST), creatinine, D-dimer, procalcitonin, acute physiology and chronic health evaluation (APACHE) Ⅱ score, sequential organ failure assessment score, length of hospital stay, length of ICU stay, and duration of mechanical ventilation were statistically significantly different in the sepsis and non-sepsis groups (all P < 0.05). The multivariate Logistic regression analysis showed that the AST [odds ratio (OR) = 1.004, 95% confidence interval (CI) (1.001, 1.008), P = 0.017], APACHEⅡ score [OR = 1.102, 95%CI (1.040, 1.166), P = 0.001], length of hospital stay [OR = 1.017, 95%CI (1.000, 1.033), P = 0.042], and duration of mechanical ventilation [OR = 1.080, 95%CI (1.027, 1.136), P = 0.003] were independent risk factors for SAP with sepsis. The area under the curve of AST, APACHEⅡ score, length of hospital stay, and duration of mechanical ventilation was 0.678, 0.723, 0.596, and 0.726, and their cut-off value at 60.5 U/L, 15.5, 28.5 d, and 4.5 d was most effective in predicting sepsis secondary to SAP. In addition, patients in the sepsis group had a significantly higher mortality rate compared to the non-sepsis group [9.55% (15/157) vs. 2.44% (5/205), χ2 = 13.205, P = 0.001].Conclusion:SAP patients with AST > 60.5 U/L, APACHEⅡ score > 15.5, hospitalization time > 28.5 d, and mechanical ventilation time > 4.5 d were prone to develop sepsis in the later period.
万方数据