谨慎使用血液培养物治疗肝硬化住院患者
Muhammad Shafiq1, Muhammad K Amin1, Muhammad A Khan1
1Internal Medicine, University of Kansas Medical Center, Kansas City, USA.
Cureus
|August 26, 2024
概括
没有其他感染或原发性硬化胆管炎的住院肝硬化患者具有较低的细菌病风险 (<1%). 这一发现有助于避免在免疫能力强的个体中不必要的血液培养.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 传染性疾病 传染性疾病
- 临床风险分层的临床风险分层
背景情况:
- 住院患有肝硬化的患者缺乏可靠的方法来提供传染病治疗指导.
- 目前的做法可能会导致不必要的血液培养,增加医疗保健成本和患者负担.
研究的目的:
- 开发一种风险分层方法,用于住院肝硬化患者的血液培养.
- 为了确定与这种人群中细菌病相关的关键风险因素.
主要方法:
- 使用2019年医疗保健成本和利用项目的回顾性队列研究 - 国家再接收数据库.
- 倾向性得分匹配用于比较患有肝硬化和没有肝硬化的患者.
- 双项回归分析了风险因素,包括并发感染和肝硬化病因.
主要成果:
- 与没有肝硬化患者相比,肝硬化患者的细菌病风险增加了1.66倍.
- 同时发生的细菌感染 (RR: 3.3) 和原发性硬化性胆管炎 (RR: 3.88) 与细菌性血有很强的关联.
- 在没有同时感染或PSC的肝硬化患者中,细菌病的发病率为<1%.
- 患有细菌病的肝硬化患者在医院住院时间较长 (3天长).
结论:
- 在免疫能力强的肝硬化患者中,如果没有同时存在的细菌感染或原发性硬化胆管炎,可以安全地省略血培养.
- 这种分层可以减少不必要的测试和相关的医疗负担.
- 由于数据库的局限性 (例如,缺少生命体征,实验室值) 需要进一步的研究来验证发现.
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