临床败血症亚型的治疗时间和死亡率
Anne Yang1,2, Jason N Kennedy3,4, Katherine M Reitz3,5
1Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh Medical Center, PA, Pittsburgh, USA. yanga7@upmc.edu.
Critical care (London, England)
|June 15, 2023
概括
快速治疗败血症,包括抗生素和捆绑治疗,可以改善生存率. 然而,在不同的败血症亚型中,有效性有很大差异,这凸显了个性化治疗策略的必要性.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 医疗保健服务研究 医疗服务研究
背景情况:
- 败血症是一种普遍且异质的疾病,死亡率高.
- 之前的研究表明,更快的抗生素注射和捆绑护理完成可以降低死亡率,但液体玻尿酸和败血症亚型的作用仍然不清楚.
研究的目的:
- 调查是否临床上可识别的败血症亚型改变了败血症护理干预和住院死亡率之间的关联.
- 分析及时服用抗生素,完成3小时的败血症捆绑和静脉注射液囊对不同败血症亚型的死亡率的影响.
主要方法:
- 在纽约州 (2015-2016) 的55,169例败血症和败血性休克住院病例的二次分析.
- 患者被分为四种临床败血症亚型 (α,β,γ,δ) 使用败血症在紧急CAre (SENECA) 方法.
- 后勤回归模型评估了关于医院死亡率的护理暴露和败血症亚型之间的相互作用.
主要成果:
- δ亚型患者的住院死亡率最高 (41%),而α亚型患者的死亡率最低 (10%).
- 三小时捆绑和抗生素启动的延迟与增加的死亡率有关,在亚型之间有显著的相互作用效应 (p < 0.05).
- 捆绑完成延迟和死亡率之间的关联在d-亚型中比α-亚型更明显. 静脉注射液体博卢斯时间与死亡率或亚型之间的差异性影响没有显著的关联.
结论:
- 及时的3小时败血症捆绑和抗生素的管理与降低死亡率有关.
- 这些干预措施的有效性因患者的特定败血症亚型而显著改变.
- 这些发现强调了考虑败血症亚型对于优化治疗策略和改善患者治疗结果的重要性.
相关概念视频
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
19
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
19
01:30Acute Pancreatitis II: Clinical Manifestations and Management
153
Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
153
01:26Urine Studies II: Urine Culture and Sensitivity Test
61
A urine culture and sensitivity test is a diagnostic procedure used to identify urinary tract bacterial infections and determine the most effective antibiotics for treatment. This test is generally preferred when a patient shows manifestations of a urinary tract infection, such as frequent or painful urination, cloudy or foul-smelling urine, or lower abdominal pain.Purpose of the TestThe primary goals of a urine culture and sensitivity test are to:Determine the specific bacteria causing the...
61
01:25Urinary Tract Infection II: Pathophysiology
20
The pathophysiology of urinary tract infections (UTIs) encompasses several progressive stages, beginning with bacterial colonization and culminating in potential systemic complications if untreated. UTIs are primarily initiated by bacteria, such as Escherichia coli, which often originate from the gastrointestinal tract and migrate to the urinary system through the periurethral area. This migration can occur via several routes, including improper hygiene practices, sexual activity, or...
20
01:27Acute Pyelonephritis I: Introduction
25
Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
25
01:26Urinary Tract Infection I: Introduction
26
Urinary tract infections (UTIs) impact various parts of the urinary system, including the kidneys, ureters, bladder, and urethra. These infections are generally bacterial, with Escherichia coli being the most common causative agent, often originating from the gastrointestinal tract. However, other bacteria, such as Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis, are also known to cause UTIs. The type, location, and underlying complexity of the UTI guide both...
26