Evaluation of clinical features and factors affecting prognosis in patients with secondary sepsis of acute gastrointestinal perforation
10.3969/j.issn.1008-9691.2017.05.004
- VernacularTitle:急性胃肠穿孔继发脓毒症的临床特征和预后影响因素评价
- Author:
Yeting ZHOU
1
;
Song YE
;
Lifei ZHANG
;
Bohua WU
;
Chenxi YANG
;
Daoming TONG
Author Information
1. 徐州医科大学附属沭阳县人民医院普外科
- Keywords:
Outcome;
Critical illness;
Organ failure;
Systemic inflammatory response syndrome;
Sepsis shock;
Sepsis;
Infection;
Gastrointestinal perforation
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2017;24(5):460-464
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the clinical features and evaluate the risk factors affecting prognosis in patients with secondary sepsis of gastrointestinal perforation (GIP). Methods A retrospective cohort study was conducted, and the patients with GIP admitted to the Department of General Surgery of Affiliated Shuyang People's Hospital of Xuzhou Medical University from January 1, 2014 to April 30, 2017 were enrolled, according to the presence or absence of sepsis occurrence, they were divided into GIP with and GIP without sepsis groups. The difference of gender, age, the time between the onset of GIP and the occurrence of sepsis, infection situation, body temperature, heart rate, respiratory frequency, white blood cell count (WBC), systemic inflammatory response syndrome (SIRS) in accord with standard, C-reactive protein (CRP), blood sugar, mean arterial pressure (MAP), lactic acid, number of cases having undergone laparoscopic surgery, sequential organ failure score (SOFA) and quick sequential organ failure score (qSOFA), Glasgow coma score(GCS), length of stay in intensive care unit (ICU), the total length of stay in hospital were compared;the status of survival and prognosis was assessed on day 30 by the Glasgow Outcome Scale (GOS). The indicators with statistical significance in the two groups were brought into the Cox regression model to analyze the independent risk factors affecting the prognosis of the patients. Results Fifty-eight patients with GIP were enrolled in this study. Among them, 22 cases developed secondary sepsis (GIP with sepsis group, there were 50.0% cases with single organ failure and 50.0% cases with multiple-organ failure, cases only in accord with 0-1 SIRS criteria accounting for 81.8%, and the mortality of secondary sepsis being 31.8%). No sepsis occurred in 36 patients (GIP without sepsis group). In GIP with sepsis group, the age, blood glucose, lactic acid, SOFA score, qSOFA, and the length of stay in ICU were significantly higher than those of GIP without sepsis group [age (years): 68.7±15.9 vs. 56.1±17.2, blood glucose (mmol/L): 6.9±2.3 vs. 5.9±1.2, lactic acid (mmol/L): 2.9±1.3 vs. 1.2±0.7, SOFA score: 5.6±3.2 vs. 0.5±0.4, qSOFA score: 1.0±0.9 vs. 0.3±0.1, the length of stay in ICU (days): 1.0 (0-4.0) vs. 0.1 (0-2.0), all P < 0.05], while MAP, GCS, and GOS scores in GIP with sepsis group were significantly lower than those in GIP without sepsis group [MAP (mmHg, 1 mmHg =0.133 kPa): 83.6±18.7 vs. 100.0±14.3, GCS score: 12.8±3.5 vs. 14.5±0.5, GOS score: 3.5±1.9 vs. 4.9±0.2, all P < 0.01]. Cox multivariable regression analysis showed: only low MAP and low GCS score were the independent risk predictors of death outcome for GIP with sepsis, the relative risk (RR) was 0.896 [95% confidence interval (CI) = 0.815-0.984, P = 0.022] and 0.585 (95%CI = 0.395-0.866, P = 0.007) respectively. Conclusion Patients with secondary sepsis following GIP have relatively high morbidity and much more risk factors, but only low MAP and low GCS score are closely associated with its high risk of death.
