Analysis Of The Risk Factors Of Refractory Shock In Patients With Septic Shock

Objective:To investigate the risk factors of refractory shock in patients with septic shock.Methods:The information of patients that admitted and treated in ICU (EICU, medical ICU and surgical ICU) of First Affiliated Hospital of Guangxi Medical University from June2011to December2013was searched with the diagnostic keywords "Sepsis, Shock" at the same time. According to the diagnosis criterion of "septic shock" a preliminary screening was made and then chose the septic shock patients in accordance with the criterion of inclusion and exclusion. The patients were divided into Research group (refractory shock group) and Control group(reversible shock group) according to whether progress to refractory shock after hospitalization of Adequately fluid resuscitation and using vasoactive drugs or (and) inotropic drugs in6hours. The study indicators which included general information, laboratory results and related treatment of selected patients with septic shock were collected and organized. Studied the indicators with univariate analysis and then made a multivariate logistic regression analysis. The factors that retained in the logistic regression model were identified as significant independent risk factors of refractory shock, and a further analysis based on the logistic regression model equation was implemented for estimating the diagnostic value of these risk factors on the occurrence of refractory shock. Results:The indicators that show statistical significance between the two groups in univariate analysis follow by MAP, APACHE Ⅱ score, comatose state, hypertension, MODS, creatinine, BNP, blood lactate,2h lactate clearance rate, PaO2, blood sugar, treatment time interval, all of the above study indicators possessed statistical significance in comparison between the two groups. Then the multivariate unconditioned logistic regression analysis shows that the independent risk factors were2h lactate clearance rate (OR=3.166E-5), lactic acid (OR=7.751), APACHE Ⅱ score (OR=1.521), hypertension (OR=1.302) and creatinine (OR=1.021).The probability of patients with septic shock to determine the occurrence of refractory shock was calculated with the probabilistic model based on logistic regression equation, it reveals the accuracy is94.62%(123/130), the sensitivity is90.91%(40/44) and the specificity is96.51%(83/86), illustrating that it has a good reference value for predicting whether patients will progress to refractory shock with the above risk factors.Conclusion:2h lactate clearance rate, high lactate value, APACHE Ⅱ score, history of hypertension, high creatinine value are the independent risk factors of patients with septic shock progress to refractory shock, with these risk factors could predict whether patients with septic shock progress to refractory shock commendably.