JAMA:脓毒症入住ICU后继发感染的发生率、死亡率研究

2016-04-11 Mechront 译 MedSci原创

脓毒症可诱导免疫抑制,导致继发感染的易感性增加,增加患者晚期死亡率。研究者对ICU患者进行了一项研究,探究伴或不伴脓毒症患者获得性感染的临床和宿主的基因组学特征、发病率和住院死亡率(ICU)。以ICU获得性感染(发病>48小时)为主要终点。通过时间-事件模型计算死亡率风险(部分死亡率可以通过消除危险因素、获得性感染得以预防)。对脓毒症患者(n = 461)亚组分析时,在基线和发生ICU获得性感染(

脓毒症可诱导免疫抑制,导致继发感染的易感性增加,增加患者晚期死亡率。研究者对ICU患者进行了一项研究,探究伴或不伴脓毒症患者获得性感染的临床和宿主的基因组学特征、发病率和住院死亡率(ICU)。

以ICU获得性感染(发病>48小时)为主要终点。通过时间-事件模型计算死亡率风险(部分死亡率可以通过消除危险因素、获得性感染得以预防)。对脓毒症患者(n = 461)亚组分析时,在基线和发生ICU获得性感染(n=19)或非感染(n=9)事件时,检测血液基因表达(白细胞全基因组转录组)。

数据显示,初始队列纳入了1719名脓毒症入院患者,其中1504名患者的中位数年龄62岁,四分位差[IQR]为51-71岁,男性有924名[61.4%]。比较队列纳入了1921名患者,其中1825名患者的中位数年龄62岁,四分位差[IQR]为49-71岁,男性有1128名[61.8%],其感染没有在最初的48小时表现出来。

ICU脓毒症和非脓毒症患者的ICU获得性感染发生率分别为13.5%(n = 232)和15.1%(n = 291)。脓毒症患者中,发展为ICU获得性感染的患者与其他患者相比,入院时疾病严重度得分更高(APACHE IV] 中位数得分, 90 [IQR, 72-107] vs 79 [IQR, 62-98]; P < .001),不过他们之间的基因表达没有差异。

第60天,脓毒症患者ICU获得性感染的人群归因死亡率为10.9% (95% CI, 0.9%-20.6%);所有脓毒症入院患者和没有ICU获得性感染患者的死亡率相差2.0% (95% CI, 0.2%-3.8%; P = .03);非脓毒症患者其ICU获得性感染的人群归因死亡率为21.1% (95% CI, 0.6%-41.7%)。与基线相比,ICU获得性感染时的基因表达情况有差异,参与糖异生、糖酵解的基因表达水平更低。

数据表明,ICU获得性感染的发生与脓毒症患者的严重程度有关,但是对整体死亡率的影响比较轻微。此外,脓毒症患者的基因组翻译与继发感染时的免疫抑制是一致的。

原始出处:

Lonneke A. van Vught, Peter M. C. Klein Klouwenberg,et al.Incidence, Risk Factors, and Attributable Mortality of Secondary Infections in the Intensive Care Unit After Admission for Sepsis.JAMA. Published online March 15, 2016. doi:10.1001/jama.2016.2691


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    2019-11-11 147455d6m36暂无昵称

    点赞

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    2019-07-17 yangchou

    很好的文章,谢谢分享

    0

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likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Mar 08 01:08:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293506, encodeId=e33529350618, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Mar 06 08:39:24 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293225, encodeId=af1f29322587, content=见识见识, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Mon Mar 05 11:57:37 CST 2018, time=2018-03-05, status=1, ipAttribution=)]
    2018-06-28 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

  4. 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likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Mar 08 01:08:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293506, encodeId=e33529350618, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Mar 06 08:39:24 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293225, encodeId=af1f29322587, content=见识见识, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Mon Mar 05 11:57:37 CST 2018, time=2018-03-05, status=1, ipAttribution=)]
    2018-06-23 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

  5. 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likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Mar 08 01:08:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293506, encodeId=e33529350618, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Mar 06 08:39:24 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293225, encodeId=af1f29322587, content=见识见识, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Mon Mar 05 11:57:37 CST 2018, time=2018-03-05, status=1, ipAttribution=)]
    2018-06-22 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

  6. 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createdName=1e145228m78(暂无匿称), createdTime=Sat Jun 23 11:47:19 CST 2018, time=2018-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=326114, encodeId=e6d4326114ae, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Jun 22 14:17:12 CST 2018, time=2018-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297384, encodeId=a1e429e384af, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sun Mar 18 10:59:28 CST 2018, time=2018-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=294903, encodeId=5c2c29490389, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Mar 10 17:39:58 CST 2018, time=2018-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293997, encodeId=bd7429399e89, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Mar 08 01:08:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293506, encodeId=e33529350618, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Mar 06 08:39:24 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293225, encodeId=af1f29322587, content=见识见识, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Mon Mar 05 11:57:37 CST 2018, time=2018-03-05, status=1, ipAttribution=)]
    2018-03-18 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

  7. 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createdName=1e145228m78(暂无匿称), createdTime=Sat Jun 23 11:47:19 CST 2018, time=2018-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=326114, encodeId=e6d4326114ae, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Jun 22 14:17:12 CST 2018, time=2018-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297384, encodeId=a1e429e384af, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Mar 08 01:08:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293506, encodeId=e33529350618, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Mar 06 08:39:24 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293225, encodeId=af1f29322587, content=见识见识, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Mon Mar 05 11:57:37 CST 2018, time=2018-03-05, status=1, ipAttribution=)]
    2018-03-10 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

  8. 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likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Mar 08 01:08:00 CST 2018, time=2018-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293506, encodeId=e33529350618, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Mar 06 08:39:24 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293225, encodeId=af1f29322587, content=见识见识, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/22/005b55a98a8b2e8ec8bd5577813de704.jpg, createdBy=29fc2176768, createdName=祝您健康, createdTime=Mon Mar 05 11:57:37 CST 2018, time=2018-03-05, status=1, ipAttribution=)]
    2018-03-08 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

  9. 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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sun Mar 18 10:59:28 CST 2018, time=2018-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=294903, encodeId=5c2c29490389, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Mar 10 17:39:58 CST 2018, time=2018-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=293997, encodeId=bd7429399e89, content=学习了.谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, 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    2018-03-06 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

  10. 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    2018-03-05 祝您健康

    见识见识

    0

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