肺炎克雷伯菌血流感染致心肌损伤患者的临床特征、危险因素和预后

IF 2.6 4区 医学 Q3 INFECTIOUS DISEASES
Qingqing Chen, Panpan Xu, Zhihui Guan, Feizhen Song, Xinhua Luo, Xijiang Zhang, Chuming Zhang, Ronghai Lin, Cheng Zheng
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引用次数: 0

摘要

背景:很少有研究描述肺炎克雷伯菌血流感染(KP-BSI)引起心肌损伤的患者。本研究旨在探讨KP-BSI致心肌损伤患者的临床特点、危险因素及预后。方法:2013年1月1日至2022年12月31日对KP-BSI患者进行双中心回顾性队列研究。临床数据是通过查阅电子病历收集的。根据高敏感性心肌肌钙蛋白I (hs-cTnI)在KP-BSI发病48 h后的水平将KP-BSI患者分为心肌损伤组和非心肌损伤组。结果:KP-BSI致心肌损伤的患者普遍比无此类损伤的患者年轻,前者的中位年龄为60岁,后者为67岁(p < 0.001)。慢性心功能不全和慢性肺部疾病等疾病在心肌损伤组(分别为10.0%和7.1%)中比无心肌损伤组(分别为4.7%和2.6%)更为普遍;P值分别为0.002和0.001)。而非心肌损伤组实体瘤发生率较高(15.3% vs. 10.4%, p=0.038)。急性生理和慢性健康评估(APACHE) II、序贯器官衰竭评估(SOFA)和Charlson共病指数(CCI)等严重程度评估在心肌损伤组均较高(均p < 0.001)。同样,重症监护病房(ICU)入院、机械通气的使用和中心静脉导管(CVC)的放置在该组中更为常见(均p < 0.001)。在感染源方面,心肌损伤组肺炎发生率较高(29.8%比15.9%,p < 0.001),而肝脏和胆道感染发生率较低。心肌损伤组的7、14和28天死亡率以及住院死亡率显著高于对照组(均p < 0.001)。多因素分析发现,年龄为0.67岁[校正优势比(aOR), 2.32;95%置信区间(CI), 1.59-3.38], SOFA评分>.6 (aOR, 3.04;95% CI, 2.10-4.39),机械通气(aOR, 1.67;95% CI, 1.15-2.39), CVC就位(aOR, 1.50;95% CI, 0.96-2.02)是KP-BSI患者心肌损伤的独立预后因素。结论:年龄较大(bbbb67岁)、较高的SOFA评分(bbbb6)、机械通气和CVC就位与心肌损伤风险增加显著相关。临床医生应警惕老年危重患者,特别是机械通气和留置CVC的危重患者发生KP-BSI时心肌损伤的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Characteristics, Risk Factors, and Outcomes of Patients With Myocardial Injury due to Klebsiella pneumoniae Bloodstream Infections.

Background: Very few studies have characterized patients with myocardial injury due to Klebsiella pneumoniae bloodstream infections (KP-BSI). Our study aimed to investigate the clinical characteristics, risk factors and outcomes of patients with myocardial injury due to KP-BSI. Methods: A double-center retrospective cohort study of patients with KP-BSI was conducted from January 1, 2013 to December 31, 2022. The clinical data was collected by reviewing electronic medical records. Classification of patients with KP-BSI into myocardial injury and nonmyocardial injury groups based on the levels of high-sensitivity cardiac troponin I (hs-cTnI) after 48 h onset of KP-BSI. Results: Patients with myocardial injury due to KP-BSI were generally younger than those without such injuries, with the former presenting a median age of 60 versus 67 in the latter (p < 0.001). Conditions like chronic cardiac insufficiency and chronic pulmonary disease were more prevalent in the myocardial injury cohort (10.0% and 7.1%, respectively) compared to those without myocardial injury (4.7% and 2.6%, respectively; p values 0.002 and 0.001). However, the nonmyocardial injury group had a higher incidence of solid tumors (15.3% vs. 10.4%, p=0.038). Severity assessments like the acute physiology and chronic health evaluation (APACHE) II, the sequential organ failure assessment (SOFA), and the Charlson Comorbidity Index (CCI) all registered higher for the myocardial injury group (all p < 0.001). Similarly, intensive care unit (ICU) admissions, use of mechanical ventilation, and central venous catheter (CVC) placement were notably more common in this group (all p < 0.001). Regarding infection sources, the myocardial injury group had a higher incidence of pneumonia as the cause for KP-BSI (29.8% vs. 15.9%, p < 0.001), whereas liver and biliary tract infections were less frequent compared to their counterparts. Mortality rates at 7, 14, and 28 days, along with in-hospital mortality, were significantly higher for those with myocardial injury (all p < 0.001). Multivariate analysis identified age > 67 [adjusted odds ratio (aOR), 2.32; 95% confidence interval (CI), 1.59-3.38], SOFA score > 6 (aOR, 3.04; 95% CI, 2.10-4.39), mechanical ventilation (aOR, 1.67; 95% CI, 1.15-2.39), and CVC in place (aOR, 1.50; 95% CI, 0.96-2.02) as independent prognostic factors for myocardial injury in KP-BSI. Conclusions: Older age (> 67 years), higher SOFA score (> 6), mechanical ventilation, and CVC in place were found to be significantly associated with an increased risk of myocardial injury. Clinical physicians should be alert to the potential for myocardial injury in elderly critically ill patients, especially those who are on mechanical ventilation and have indwelling CVC, in the event of KP-BSI.

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来源期刊
CiteScore
4.30
自引率
0.00%
发文量
108
审稿时长
>12 weeks
期刊介绍: Canadian Journal of Infectious Diseases and Medical Microbiology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to infectious diseases of bacterial, viral and parasitic origin. The journal welcomes articles describing research on pathogenesis, epidemiology of infection, diagnosis and treatment, antibiotics and resistance, and immunology.
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