败血症后从外科重症监护病房出院后的1年死亡率的预测因素
Predictors of 1-year mortality following discharge from the surgical intensive care unit after sepsis
影响因子:2.70000
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
摘要
后综合症与长期死亡率显着有关。这项研究的目的是确定从外科重症监护病房出院1年内死亡率的预测指标。我们回顾性地审查了患有败血症的手术重症监护病房的患者（顺序器官衰竭评估评估评分≥2，2011 - 2022年）。将出院1年内死亡的人（n = 171）与幸存者进行了比较（n = 639）。比较了基线特征，败血症和住院数据。进行了多次逻辑回归，以确定出院后的1年死亡率的预测因子，与幸存者相比，死者年龄较大，从另一家机构转移的可能性较小（35％vs 46％，P = .003），患有更多的转移性癌症（9％vs 1％，P <.01），或III级+III+III+Charmey Kidney病（III+Charmey Kidney病）（16％VS 16％VS 7％，PS 7％，p <。01<.01）。入院顺序器官衰竭评估评分，乳酸和加压剂的使用是可比的。一年的死亡率队列表现出呼吸道增加（15％vs 9％）和腹部（66％vs 54％）感染（p <.01），中位停留时间（29 vs 19，p <.005），肾衰竭（14％vs 9％vs 9％，p = .048），以及依赖排放。死亡的调整后预测因素包括年龄（OR] 1.03，95％置信区间[CI] 1.02-1.05），转移性癌症（OR 8.0，95％CI 2.6-25），慢性肾脏疾病（OR 2.8，95％CI 1.4-5.6），住院时间长度（OR 1.02，95％CI CI 1.05％1.03）。与最低的四分位数相比，在顶级四分位数（> 32天）中的住院时间与降低后死亡率增加了3倍（<10天）。我们确定了败血症后的独立预测因子，包括年龄，住院时间，依赖的出院时间，依赖的出院和III期+年横肾病。这些数据可以识别出可用于更紧密随访的高危患者。
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.