探索急诊室败血症患者的温度轨迹
Norawit Kijpaisalratana1, Ahmad Hassan2, Boyu Peng2
1Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Department of Emergency Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
The American journal of emergency medicine
|July 5, 2025
概括
败血症患者表现出不同的体温模式,低温与最高死亡率有关. 识别这些不同的温度特征,而不仅仅是发烧,对于改善急诊室败血症患者的治疗结果至关重要.
科学领域:
- 紧急医疗 紧急医疗
- 关键护理医学 关键护理医学
- 临床信息学 临床信息学
背景情况:
- 败血症是一个重大的全球卫生挑战,特别是在急诊室 (ED).
- 虽然快速序列器官衰竭评估 (qSOFA) 得分扩大了败血症诊断,但传统的依赖体温需要重新评估.
- 了解血症中不同的体温模式对于准确的诊断和治疗至关重要.
研究的目的:
- 分析急诊室败血症患者体温的不同模式.
- 调查这些温度模式对患者治疗和结果的影响.
- 评估体温轨迹在败血症管理中的有用性.
主要方法:
- 使用MIMIC-IV数据库进行回顾性队列研究.
- 基于小组的轨迹建模,以确定在ED triage 12小时内诊断出败血症患者的体温模式.
- 统计分析包括ANOVA和千二测试,以比较患者的特征和确定温度子组的结果.
主要成果:
- 确定了四种不同的体温模式:低温 (0.9%),正常热 (74.1%),渐进性发烧 (10.7%) 和发烧解决 (14.4%).
- 低温组的死亡率最高 (37.5%).
- 在Normothermic,Progressive Fever和Fever Resolver组的死亡率分别为11.7%,9.14%和9.78% (p < 0.001).
结论:
- 发烧不是普遍存在的或可靠的指标来诊断败血症.
- 显著比例的败血症患者出现正常热或低温,低温与死亡率增加有关.
- 将更广泛的体温模式纳入败血症评估协议中可能会改善患者的治疗结果.
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