{"title":"原发感染部位是急诊科患者发生败血症的预测因素","authors":"","doi":"10.1016/j.jemermed.2024.01.016","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Sepsis is a life-threatening condition but predicting its development and progression remains a challenge.</p></div><div><h3>Objective</h3><p>This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients.</p></div><div><h3>Methods</h3><p><span><span><span>Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), </span>lower respiratory tract (LRI), </span>urinary tract<span> (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and </span></span>urine culture<span><span> positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different </span>logistic regression approaches were used for analysis with URI used as the reference variable.</span></p></div><div><h3>Results</h3><p><span>LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07–6.24) and septic shock (RRR 21.2; 95% CI 17.99–24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41–9.14), </span>intensive care unit admission (OR 4.27; 95% CI 3.84–4.74), in-hospital mortality (OR 6.93; 95% CI 5.60–8.57), and 30-day mortality (OR 7.34; 95% CI 5.86–9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI.</p></div><div><h3>Conclusions</h3><p><span>Primary infection sites including LRI and </span>UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 2","pages":"Pages e128-e137"},"PeriodicalIF":1.2000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Primary Infection Site as a Predictor of Sepsis Development in Emergency Department Patients\",\"authors\":\"\",\"doi\":\"10.1016/j.jemermed.2024.01.016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Sepsis is a life-threatening condition but predicting its development and progression remains a challenge.</p></div><div><h3>Objective</h3><p>This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients.</p></div><div><h3>Methods</h3><p><span><span><span>Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), </span>lower respiratory tract (LRI), </span>urinary tract<span> (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and </span></span>urine culture<span><span> positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different </span>logistic regression approaches were used for analysis with URI used as the reference variable.</span></p></div><div><h3>Results</h3><p><span>LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07–6.24) and septic shock (RRR 21.2; 95% CI 17.99–24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41–9.14), </span>intensive care unit admission (OR 4.27; 95% CI 3.84–4.74), in-hospital mortality (OR 6.93; 95% CI 5.60–8.57), and 30-day mortality (OR 7.34; 95% CI 5.86–9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI.</p></div><div><h3>Conclusions</h3><p><span>Primary infection sites including LRI and </span>UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.</p></div>\",\"PeriodicalId\":16085,\"journal\":{\"name\":\"Journal of Emergency Medicine\",\"volume\":\"67 2\",\"pages\":\"Pages e128-e137\"},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0736467924000155\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0736467924000155","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景败血症是一种危及生命的疾病,但预测其发展和恶化仍是一项挑战。目标本研究旨在评估感染部位对急诊科患者败血症发展的影响。方法数据收集自 2016 年 1 月至 2019 年 12 月期间的单中心急诊科。根据《医学术语系统化-临床术语》(SNOMED-CT)定义的上呼吸道(URI)、下呼吸道(LRI)、泌尿道(UTI)或皮肤/软组织(SSTI)感染,纳入有感染记录的患者就诊情况。主要结果是根据 SEP-1/2 标准定义的脓毒症和/或脓毒性休克的发生情况。次要结果包括医院处置和住院时间、血和尿培养阳性率、抗生素用量、血管加压药使用、院内死亡率和 30 天死亡率。结果LRI与脓毒症(RRR 5.63;95% CI:5.07-6.24)和脓毒性休克(RRR 21.2;95% CI 17.99-24.98)的发生以及住院时间最相关。98),以及入院率(OR 8.23;95% CI 7.41-9.14)、入住 ICU(OR:4.27;95% CI 3.84-4.74)、住院死亡率(OR:6.93;95% CI:5.60-8.57)和 30 天死亡率(OR:7.34;95% CI:5.86-9.19)。结论包括 LRI 和 UTI 在内的原发感染部位与急诊科感染患者的败血症、住院、住院时间和死亡率密切相关。
Primary Infection Site as a Predictor of Sepsis Development in Emergency Department Patients
Background
Sepsis is a life-threatening condition but predicting its development and progression remains a challenge.
Objective
This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients.
Methods
Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), lower respiratory tract (LRI), urinary tract (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and urine culture positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different logistic regression approaches were used for analysis with URI used as the reference variable.
Results
LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07–6.24) and septic shock (RRR 21.2; 95% CI 17.99–24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41–9.14), intensive care unit admission (OR 4.27; 95% CI 3.84–4.74), in-hospital mortality (OR 6.93; 95% CI 5.60–8.57), and 30-day mortality (OR 7.34; 95% CI 5.86–9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI.
Conclusions
Primary infection sites including LRI and UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.
期刊介绍:
The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections:
• Original Contributions
• Clinical Communications: Pediatric, Adult, OB/GYN
• Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care
• Techniques and Procedures
• Technical Tips
• Clinical Laboratory in Emergency Medicine
• Pharmacology in Emergency Medicine
• Case Presentations of the Harvard Emergency Medicine Residency
• Visual Diagnosis in Emergency Medicine
• Medical Classics
• Emergency Forum
• Editorial(s)
• Letters to the Editor
• Education
• Administration of Emergency Medicine
• International Emergency Medicine
• Computers in Emergency Medicine
• Violence: Recognition, Management, and Prevention
• Ethics
• Humanities and Medicine
• American Academy of Emergency Medicine
• AAEM Medical Student Forum
• Book and Other Media Reviews
• Calendar of Events
• Abstracts
• Trauma Reports
• Ultrasound in Emergency Medicine