Clinical Features Of Patients With Sepsis In ICU And The Analysis Of Prognosis Related Risk Factors

Objective: To explore the clinical characteristics and prognosis related risk factors of patients with sepsis in ICU,so as to provide reference for the clinical treatment of patients with late-stage sepsis.Methods: Selected 112 patients with sepsis as the research object from January 2017 to December 2018 in the hospital treatment,according to its clinical outcome will be divided into 28 days survival group(73 cases)and death group(39 cases).According to the diagnosis criteria for sepsis 3.0 which provided by SCCM and ESICM in February2016.Collected the general epidemiological data of patients,1,3,7 days after admission of patients from arterial blood detection of blood lactate,blood gas analysis,venous blood detection routine blood,blood biochemistry,calcitonin original index analysis and C-reactive protein,infected foci,germiculture,the main intervention treatment(invasive operations,use of immunosuppressant agent,chemotherapy,antibiotics),the points-scoring system(APACHE-?,GCS)and prognostic outcomes(survivor and nosurvivor).Univariate and multivariate Logistic regression analysis was adopted to analyze the correlation between ICU hospitalization time,number of patients with organ failure,deep venous catheterization,mechanical ventilation,blood products and other factors and the mortality of patients,and to explore the risk factors and protective factors of the mortality of sepsis patients,so as to give some clinical enlightenment.Results: The difference of two groups patients have no significance in the proportion of COPD,hypertension,diabetes,chronic kidney disease and autoimmune system(P>0.05).The difference of two groups patients have significance in the proportion ofmalignant tumor,invasive operations(Mechanial Ventilation,deep vein catheterization,and surgery(P<0.05).The difference of two groups patients have no significance in the other invasive operations(P>0.05).The difference of two groups patients have significance in the other intervention treatments(chemotherapy,use of immuno-suppressant agent),APACHE II,length of stay in the ICU and other risk factors leading to increased case fatality rate of the patients(P<0.05).The differences were statistically significant in Lac,PCT,CRP statistical analysis: all patients with sepsis were sampled from arterial blood on the first,third and seventh days after admission for relevant item detection.With the increase of patients in the ICU days,Lac survival group,concentration of PCT and CRP statistics gradually decreased,but death group reflects the trend of rising,the difference is statistically significant(P<0.05),the death of patients with sepsis in the ICU,blood internal blood lactic acid,calcitonin original and C-reactive protein concentration has the direct correlation,the concentration of growth and is related to the mortality of patients,the difference is statistically significant.Pathogenic bacteria distribution and composition: the gram-positive bacteria,staphylococcus aureus,enterococcus aureus and other three types were mainly involved.The proportion of gram-positive bacteria,staphylococcus aureus,enterococcus aureus between the two groups were all survival group < death group,P<0.05,and the difference was statistically significant.The main strains of gram-negative bacteria inclued acinetobacter baumannii,pseudomonas aeruginosa,escherichia coli,klebsiella pneumoniae and other types.The study data suggested that the proportion between each group was survival group < death group,P<0.05,and the difference was statistically significant.In the statistical analysis of fungi,the main items involved were candida albicans,aspergillus aspergillus,and candida tropialis.The proportion type of each group was survival group and > death group,P>0.05,and the difference was not statistically significant.Finally,the virus analysis process showed that the proportion of the two groups was similar,P>0.05,and the difference was not statistically significant.Univariate analysis of prognosis of the two groups: The difference of two groups patients have no significance in the gender,COPD,chronic kidney disease,autoimmune disease and average number of ICU days(P>0.05).The difference of two groups patients have significance in the average age,APACHE II,mechanical ventilation,deep venipuncture,malignant tumor,vascular active drugs such as statistics(P<0.05).All of them are risk factors leading to increased mortality in patients with sepsis in ICU.Prognosis of multi-factor analysis: The difference of two groups patients have significance in the average age,APACHE II score,septic shock,mechanical operation,vascular active drug use(P<0.05),for its the independent risk factors of death in patients with sepsis in the ICU.Conclusion: Many clinical operations will lead to the increase of mortality in patients with sepsis in ICU,such as bacterial infection,mechanical ventilation,deep vein catheterization,and the use of vasoactive drugs.Many of these items,such as mean age,APACHE II,mechanical ventilation,deep venous catheterization,malignant tumors,and vasoactive drugs,are independent risk factors leading to increased mortality in patients with sepsis in ICU,which have certain clinical reference value.