败血症患者主要胃肠道出血的危险因素:多中心回顾性研究
Yi Zhang1, Haibo Zhang2, Yuanyuan Feng3
1Department of Emergency Medicine, Medical Center of Trauma and War Injury, Daping Hospital, Army Medical University, Chongqing, China.
败血症患者的主要胃肠道出血 (MGB) 显著增加死亡率. 关键的危险因素包括老年,功能障碍和胃肠道感染,有助于早期风险分层以获得更好的结果.
科学领域:
- 临界护理医学 临界护理医学
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
背景情况:
- 大型胃肠道出血 (MGB) 是败血症的严重并发症,与患者预后不佳有关.
- 确定MGB的预测因子对于败血症患者的临床风险分层至关重要.
研究的目的:
- 在大量的败血症患者的多中心队列中确定MGB的独立预测因子.
- 为了促进MGB在败血症中的临床风险分层.
主要方法:
- 来自四家三级医院的10,249名败血症患者 (2016-2023) 的回顾性分析.
- 数据包括人口统计,并发症,感染源,实验室参数和治疗方法.
- MGB定义为明显出血,血红蛋白下降>20 g/L或在28天内需要输血.
主要成果:
- 2.0%的患者患有MGB,住院死亡率明显高 (44.0%vs17.0%).
- 独立的MGB风险因素:功能障碍,恶性病/免疫抑制,胃肠道感染,BUN升高和年龄较大.
- 保护因素:尿路感染和更高的基线血红蛋白水平. 预测模型的AUC为0.702.
结论:
- 败血症中的MGB虽然不常见,但与死亡率大幅增加有关.
- 高龄,功能障碍,BUN升高和胃肠道来源是MGB风险的主要驱动因素.
- 早期风险分层和高风险患者的有针对性的预防对于改善生存率至关重要.
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