脓毒症腹部手术患者累积90-D死亡率的预测因素

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-04-28 DOI:10.1016/j.jss.2025.03.052

Shachi Srivatsa MD , Courtney M. Collins MD , Whitney Kellett MD, PhD , Daniel S. Eiferman MD, MBA , Jon Wisler MD, MS , Anahita Jalilvand MD, PhD

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引用次数: 0

摘要

接受急诊普通外科手术的感染性手术患者是一个独特的人群，面临着独特的挑战。本研究旨在确定90天累积死亡率的预测因素，包括临床和社会经济因素，并分析该队列的死亡原因。方法回顾性分析2011 - 2019年在某外科重症监护病房接受急诊腹腔手术的脓毒症（序贯器官衰竭评估评分≥2分）患者（n = 498例）。分析了人口统计学、合并症、败血症表现和社会经济指标，包括区域剥夺指数（ADI）。使用多元逻辑回归确定死亡率的独立预测因子。对死亡原因进行分类和分析。结果498例患者中，46% （n = 229）在90 d内死亡。非幸存者年龄较大（65±13.7 vs 61.2±13.5），P <；0.01)，更经常从外部设施转移(59%对46%，P <；0.01)，肝脏疾病、慢性肾脏疾病、转移性癌症、肥胖的发生率较高，Charlson合并症指数评分较高(P <；0.01)。90 d死亡率的独立预测因子包括入院序贯器官衰竭评估评分、血清乳酸、肥胖、ADI、Charlson合并症指数和转移状态。ADI仍然是一个重要的预测因子，而贫困社区指数没有。在死亡病例中，76.9%是院内死亡，最常见的原因是腹腔内疾病（35.4%）、多系统器官衰竭（25.2%）和肺部原因（16.4%）。结论腹内灾难、多器官功能衰竭和肺部并发症是脓毒症急诊普外科患者死亡的主要原因。ADI是死亡率的一个强有力的社会经济预测指标，强调了将社会决定因素纳入风险评估和量身定制的护理策略的必要性。发展全面的风险模型可以提高这一关键人群的预后和指导临床决策。

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Predictors of Cumulative 90-D Mortality for Septic Patients Undergoing Abdominal Surgery

Introduction

Septic surgical patients undergoing emergency general surgery represent a distinct population with unique challenges. This study aimed to identify predictors of cumulative 90-d mortality, including clinical and socioeconomic factors, and to analyze causes of death in this cohort.

Methods

A retrospective analysis was conducted on patients admitted to a surgical intensive care unit from 2011 to 2019 with sepsis (sequential organ failure assessment score ≥2) undergoing emergency intra-abdominal surgery (n = 498). Demographics, comorbidities, sepsis presentation, and socioeconomic metrics, including the area deprivation index (ADI), were analyzed. Independent predictors of mortality were identified using multiple logistic regression. The causes of death were categorized and analyzed.

Results

Among 498 patients, 46% (n = 229) died within 90 d. Nonsurvivors were older (65 ± 13.7 versus 61.2 ± 13.5 y, P < 0.01), more often transferred from external facilities (59% versus 46%, P < 0.01), and had higher rates of liver disease, chronic kidney disease, metastatic cancer, obesity, and higher Charlson comorbidity index scores (P < 0.01 for all). Independent predictors of 90-d mortality included admission sequential organ failure assessment scores, serum lactate, obesity, ADI, Charlson comorbidity index, and transfer status. ADI remained a significant predictor, while the distressed communities index did not. Of the deaths, 76.9% were in-hospital deaths, with intra-abdominal catastrophes (35.4%), multisystem organ failure (25.2%), and pulmonary causes (16.4%) as the most common causes.

Conclusions

Intra-abdominal catastrophes, multiorgan failure, and pulmonary complications are leading causes of death in septic emergency general surgery patients. ADI is a robust socioeconomic predictor of mortality, underscoring the need for integrating social determinants into risk assessment and tailored care strategies. Developing comprehensive risk models may enhance prognostication and guide clinical decision-making in this critical population.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.