Importance of Source Control in the Subgroup of Intra-Abdominal Infections for Septic Shock Patients: Analysis of 390 Cases.

IF 2 4区医学 Q3 HEMATOLOGY

Mediterranean Journal of Hematology and Infectious Diseases Pub Date : 2024-07-01 eCollection Date: 2024-01-01 DOI:10.4084/MJHID.2024.051

Uğur Önal, Deniz Akyol Seyhan, Olcay Buse Ketenoğlu, Merve Mert Vahabi, Dilşah Başkol Elik, Seichan Chousein Memetali, Gamze Şanlıdağ İşbilen, Cansu Bulut Avşar, Arda Kaya, Ayse Uyan-Önal, Nazlıhan Yalçın, Günel Guliyeva, Şükrü Dirik, Oğuzhan Acet, Damla Akdağ, Melike Demir Görür, Osman Bozbıyık, Berk Göktepe, Tufan Gümüş, İlkin Çankayalı, Kubilay Demirağ, Mehmet Uyar, Hilal Sipahi, Huseyin Aytac Erdem, Meltem Işıkgöz Taşbakan, Bilgin Arda, Şöhret Aydemir, Sercan Ulusoy, Oguz Resat Sipahi

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引用次数: 0

Abstract

Background: This study aimed to evaluate the epidemiology of septic shock (SS) associated with intraabdominal infections (IAI) as well as associated mortality and efficacy of early source control in a tertiary-care educational hospital.

Methods: Patients who had SS with IAI and consulted by Infectious Diseases consultants between December 2013 and October 2022 during night shifts in our centre were analyzed retrospectively.

Results: A total number of 390 patients were included. Overall, 30-day mortality was 42.5% on day 3, while day 14 and 30 mortality rates were 63.3% and 71.3%, respectively. Source control by surgical or percutaneous operation was performed in 123 of 390 cases (31.5%), and the mortality rate was significantly lower in cases that were performed source control at any time during SS (65/123-52.8% vs 213/267-79.8%, p<0.001). In 44 of 123 cases (35.7%), source control was performed during the first 12 hours, and mortality was significantly lower in this group versus others (24/44-54.5% vs 254/346-73.4%, p=0.009). On the other hand, female gender (p<0.001, odds ratio(OR)= 2.943, 95%CI=1.714-5.054), diabetes mellitus (p= 0.014, OR=2.284, 95%CI=1.179-4.424), carbapenem-resistant Gram-negative etiology (p=0.011, OR=4.386, 95%CI=1.398-13.759), SOFA≥10 (p<0.001, OR=3.036, 95%CI=1.802-5.114), lactate >3 mg/dl (p<0.001, OR=2.764, 95%CI=1.562-4.891) and lack of source control (p=0.001, OR=2.796, 95%CI=1.523-5.133) were significantly associated with 30-day mortality in logistic regression analysis.

Conclusion: Source control has a vital importance in terms of mortality rates for IAI-related septic shock patients. Our study underscores the need for additional research, as the present analysis indicates that early source control does not manifest as a protective factor in logistic regression.

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脓毒症休克患者腹腔内感染亚群中病源控制的重要性：对 390 例病例的分析

背景：本研究旨在评估一家三级医疗教育医院中与腹腔内感染（IAI）相关的脓毒性休克（SS）的流行病学、相关死亡率以及早期病源控制的效果：方法：回顾性分析2013年12月至2022年10月期间在本中心夜班期间由感染科顾问诊治的伴有腹腔内感染的休克患者：结果：共纳入390名患者。总体而言，第 3 天的 30 天死亡率为 42.5%，第 14 天和第 30 天的死亡率分别为 63.3% 和 71.3%。390 例病例中有 123 例（31.5%）通过手术或经皮操作进行了源头控制，在 SS 期间任何时候进行源头控制的病例死亡率明显较低（65/123-52.8% vs 213/267-79.8%，p3 mg/dl）：就 IAI 相关脓毒性休克患者的死亡率而言，源控制至关重要。我们的研究强调了进行更多研究的必要性，因为目前的分析表明，早期源控制在逻辑回归中并不表现为一个保护因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mediterranean Journal of Hematology and Infectious Diseases Medicine-Hematology

CiteScore

4.20

自引率

6.20%

发文量

113

审稿时长

12 weeks

期刊介绍： Reciprocal interdependence between infectious and hematologic diseases (malignant and non-malignant) is well known. This relationship is particularly evident in Mediterranean countries. Parasitosis as Malaria, Leishmaniosis, B Hookworms, Teniasis, very common in the southeast Mediterranean area, infect about a billion people and manifest prevalently with anemia so that they are usually diagnosed mostly by experienced hematologist on blood or bone marrow smear. On the other hand, infections are also a significant problem in patients affected by hematological malignancies. The blood is the primary vector of HIV infection, which otherwise manifest with symptoms related to a reduction in T lymphocytes. In turn, infections can favor the insurgency of hematological malignancies. The causative relationship between Epstein-Barr virus infection, Helicobacter pylori, hepatitis C virus, HIV and lymphoproliferative diseases is well known.