The Comprehensive Analysis Of Risk Factors For Death Patient With Sepsis In EICU

Objective: To study the independent risk factors of death patients with sepsis in EICU.Methods: 1.Totally 268 patients with sepsis from April 2014 to December 2015 who admission in EICU of The Second Hospital of Tianjin Medical University above48 h were retrospective analyzed.2.According to the diagnosis criteria which provided by Society of Critical Care Medicine in 2001.3.The septic patient were classified into survivors and non-survivors.4.Collected the case gender,age,the length of stay in EICU,the past medical history in Respiratory system,Digestive System,Urinary System,Circulation System,Diabetes mellitus,Nervous System,Surgery history,the history of transfusion and the allergic history),life index(temperature,breathing,heat rate,blood pressure,MAP),nutrition and consciousness,the worst laboratory index(WBC,Hb,PLT,Hct,PT,Fbg,D-Dimer,BUN,Scr,Bil,ALT,AST,Alb,Na+,K+,Cl-,CO2 CP,CK-MB,Tn-I,BNP,p H,Lac,Pa O2,Aa DO2,Fi O2,Glu,PCT)within 48 h,germiculture,the main intervention treatment(DA,CRRT and Mechanial Ventilation),the points-scoring system(APACHE-II,SOFA,GCS)and prognostic outcomes(survivor and nonsurvivor).5.The statistical method: All the data were analyzed by SPSS 19.0 software.Measurement data: The data according to normal distribution expressed by(`x±s),comparing among groups performed by T test,and the data unaccording to normal distribution expressed by Mean(P25,P75),comparing among groups performed with non-parametric Mann-Whitney U test;Enumeration data: Comparing data were expressed by x2 test,the analysis of risk factors was performed with Logistic regression analysis,discribing the independent risk factors with the receiver operator characteric,evaluating the significance of prognosis by comparving the size of under ROC curve,so the diagnostic accuracy of related indicators was evaluated by ROC curves.Select P<0.05 as statistical difference.Results: 1.163 cases were discharged hospital with condition improved in268 case,105 cases were death in room of EICU.The total death rate is 39.2%(105/168).2.The difference of two groups patients have no significance in gender,Respiratory systerm,Digedtive System,Circulation System,Diabetes mellitus,Nevous System,Surgery history,the history of transfusion and the allergic history,life index(temperature,breathing,heat rate,blood pressure,MAP),smoking,drinking,the conscionsness states,the laboratory index(WBC,PLT,Fbg,Na+,Cl-,AST,ALT,CO2 CP,Fi O2,PO2,Glu,Bil,CK-MB,Tn I,PCT,GCS scores)within 48h(P>0.05).The difference of two groups patients have significance in age,the past medical history in Urinary System,the nutrition states,Hb,Hct,PT,D-Dimer,BUN,Scr,Alb,K+,Lac,Aa DO2,UV,BNP,shock,the use of MV,the use of CRRT,the APACHE-II scores,the SOFA scores,the positive result of bacterial culture(P<0.05).3.Bacterial distribution: The compared results of two groups expressed by x2 test or continuous correction test showed that the results of culture of 4 cases(2.5%)of survivor group of infection of E-coli were positive,10 cases(9.5%)of non-survivor group positive,the difference was Statistically significance(P <0.05),the comparison of other cultured positive bacteria have not statistical significance(P> 0.05).4.Univariate analysis:There are significacnt difference in age,the past medical history in Urinary System,the nutrition states,PT,Fbg,D-Dimer,BUN,Scr,Bil,AST,ALT,Alb,K+,Lac,Aa DO2,UV,BNP,shock,the positive of bacterial culture,APACHE-II,SOFA,the Hb,Hct,Alb,the use of MV and CRRT(P<0.05).5.Multivariance analysis: The above indexes with statistical significance were brought into multivariance logistic regression analysis.The results suggested that the difference in ALT,AST,Lac,DA,UV,Shock,MV have statistical significance,among them the UV and MV are the protective factors(B<0,P<0.05).Conclusions: The high value of ALT,AST,Lac,DA and the state of shock are the independent risk factors of septic patients in EICU,the high value of UV and the use of mechanical ventilation are protective factors,these indexes will be of great significance in prognosis evaluation of sepsis patients in EICU.