敗血症患者における血行動態パラメータと28日間生存率との関連の分析

This study aimed to explore the relationship between hemodynamic parameters and 28-day survival in patients with sepsis and to evaluate their prognostic value. This retrospective observational study included 165 patients with sepsis admitted to the ICU of our hospital between March 2021 and March 2024. Patients were categorized into survival (n = 126) and non-survival groups (n = 39) based on 28-day outcomes. Hemodynamic assessments within 24 hours of ICU admission included sequential organ failure assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), lactate, cardiac output (CO), and dynamic indicators such as stroke volume variation (SVV), pulse pressure variation (PPV), and passive leg raise (PLR)-induced CO change. Logistic regression was applied to identify risk factors, and receiver operating characteristic (ROC) curves were used to assess predictive ability. Compared with survivors, non-survivors had higher SOFA (median 12 vs 8, P < .001) and APACHE II scores (median 26 vs 18, P < .001), higher lactate levels (median 4.1 vs 2.3 mmol/L, P < .001), and lower MAP (72 vs 78 mm Hg, P = .012). Multivariate regression identified SOFA score (OR = 1.27, 95% CI: 1.04-1.55, P = .016), MAP (OR = 0.95, 95% CI: 0.91-0.99, P = .012), lactate (OR = 1.52, 95% CI: 1.11-2.08, P = .009). The combined model showed an AUC of 0.851 (95% CI: 0.811-0.891). Hemodynamic parameters, particularly SOFA score, MAP, lactate, and cardiac function indicators, were significantly associated with 28-day mortality in sepsis patients. These findings suggest that integrating static and dynamic hemodynamic monitoring may support early risk stratification, although further prospective multicenter validation is needed.