术后败血症患者外科重症监护室出院后1年死亡预测因素
Predictors of 1-year mortality following discharge from the surgical intensive care unit after sepsis
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影响因子:2.7
分区:医学2区 / 外科2区
发表日期:2025 Mar
作者:
Anahita Jalilvand, Tracie Terrana, Whitney Kellett, Courtney Collins, Megan Ireland, Wendy Wahl, Jon Wisler
DOI:
10.1016/j.surg.2024.08.037
摘要
术后败血症综合征与显著的长期死亡率相关。本研究旨在确定外科重症监护室（SICU）出院后1年内的死亡预测因素。回顾分析2011年至2022年期间收治的SICU败血症患者（序贯器官衰竭评分≥2）。比较出院后1年内死亡（n=171）与存活者（n=639）的基线特征、败血症表现及住院资料。采用多因素逻辑回归分析，确定预测1年死亡的因素。结果显示，死亡组年龄较大，转院比例较低（35% vs 46%，P=0.003），有转移性癌（9% vs 1%，P<0.01）或III期+慢性肾病（16% vs 7%，P<0.01）。入院时序贯器官衰竭评分、乳酸水平及血管加压素使用情况无显著差异。死亡组表现出呼吸道（15% vs 9%）及腹部感染（66% vs 54%）比例升高，住院时间中位数为29天（比对照组19天，P<0.005），肾功能衰竭（14% vs 9%，P=0.048）及依赖性出院比例增加。调整后预测死亡的独立因素包括年龄（OR 1.03，95% CI 1.02-1.05）、转移性癌（OR 8.0，95% CI 2.6-25）、慢性肾病（OR 2.8，95% CI 1.4-5.6）、住院时间（OR 1.02，95% CI 1.0-1.03）及依赖性出院。住院时间位于最高四分位（>32天）者，其术后死亡风险较最低四分位（<10天）高出3倍。这些数据识别了败血症后出院后死亡的独立预测因素，包括年龄、住院时间、依赖性出院和III期+慢性肾病，有助于针对高风险患者进行更密切的随访。由Elsevier Inc.发表。
Abstract
Postsepsis syndrome is associated with significant long-term mortality. The objective of this study was to determine predictors of mortality within 1 year of discharge from the surgical intensive care unit.We retrospectively reviewed patients admitted to a surgical intensive care unit with sepsis (sequential organ failure assessment score ≥2, 2011-2022). Those who died within 1 year from discharge (n = 171) were compared to survivors (n = 639). Baseline characteristics, sepsis presentation, and hospitalization data were compared. A multiple logistic regression was performed to determine predictors of 1-year mortality after discharge.Compared with survivors, those who died were older, less likely to be transferred from another institution (35% vs 46%, P = .003), had more metastatic cancer (9% vs 1%, P < .01), or stage III + chronic kidney disease (16% vs 7%, P < .01). Admission sequential organ failure assessment score, lactate, and vasopressor use were comparable. The 1-year mortality cohort exhibited increased respiratory (15% vs 9%) and abdominal (66% vs 54%) infections (P < .01), median length of stay (29 vs 19, P < .005), renal failure (14% vs 9%, P = .048), and dependent discharge. Adjusted predictors of death included age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.02-1.05), metastatic cancer (OR 8.0, 95% CI 2.6-25), chronic kidney disease (OR 2.8, 95% CI 1.4-5.6), length of stay (OR 1.02, 95% CI 1.0-1.03), and dependent discharge. A length of stay in the top quartile (>32 days) was associated with a 3-fold increase in postdischarge mortality compared with the lowest quartile (<10 days).We identified independent predictors of postdischarge mortality following sepsis, including age, length of stay, dependent discharge, and stage III + chronic kidney disease. These data can identify at-risk patients who can be targeted for closer follow-up.Published by Elsevier Inc.