| Objectives : 1)To conduct a retrospective study for the epidemiological data of hospitalized patients diagnosed with sepsis in Renji hospital affiliated to Shanghai Jiaotong university school of medicine between 2011-2016.2)Clinical data for consecutive different patients diagnosed with sepsis who were admitted in the Emergency Department were further collected.The demographic data,etiologies,laboratory biomarkers,image characteristics,and clinical outcomes were analyzed to explore the risk factors related to septic organ dysfunction and clinical prognosis factors.3)We selected 63 cases diagnosed as liver abscess among the 220 sepsis patients to explore the etiologies,pathogen and related prognostic factors.Methods: 1)We conducted a retrospective study of the epidemiological data of sepsis patients during January 2010 to December 2016.A total of 816 hospitalized patients diagnosed as ?sepsis or septic shock‘ in Renji hospital affiliated to Shanghai Jiaotong university school of medicine were enrolled.The distribution of departments,characteristics of infection,clinical features,classification of primary diseases were collected and analyzed.2)To further evaluate the prognosis of patients with sepsis.We selected 220 hospitalized patients admitted in emergency ward and emergency intensive care unit(EICU)in Renji hospital during January 2012 to Demcember 2016,and all patients were up to the present sepsis 3.0 for the new definition of sepsis.We collected all the clinical information including demographic data,the infection,clinical and biochemical indexes,etiology examination result,the affected organs,simultaneous Acute Physiology and Chronic Health Evaluation II(APACHE II)score,Sequential Organ Failure Assessment(SOFA)score and recorded the largest SOFA score in the course of the disease.According to the prognosis,patients were divided into survival group(n =169)and death group(n =51).We compared two groups through single factor and multiple factors Logistic regression analysis.3)Clinical relevant analysis of liver abscess.We selected 63 hospitalized patients admitted in emergency ward and emergency care unit(EICU)to analyzed its clinical manifestation,common factors,etiology,treatment and outcome etc,compared simple antibiotic treatment with ultrasound B guided puncture followed by catheter drainage of purulence,and studied the distinctive characteristics of sepsis caused by liver abscess.Results: 1)The average age of patients with sepsis in Renji hospital was 60.52±19.25 years in nearly six years,the median length of hospital stay was 14(9,26)days and the median hospital charge was 38,618.87(21,994.39,21,994.39)RMB yuan.The proportion of health care was higher in male patients(p = 0.042),yielding higher hospitalization cost(p<0.001).Most patients with sepsis(n= 297,36.40%)were distributed in the Emergency Department.Respiratory system disease was the most primary disease.The most common infected site was lung.In a proportion of patients(n=211,25.86%),no clear or suspected primary infection site was found.2)Comparing the clinical features of two groups,we found that patients of sepsis in the death group had significantly longer mechanical ventilation time(p=0.001),lower serum albumin(p<0.001),higher serum total bilirubin(p=0.008),higher serum creatine(p =0.005)and higher D-dimmer level(p=0.03).Their Glasgow,APACHE II score and SOFA score were significantly higher,too(p< 0.05).Higher APACHE II score was the independent risk factor of death in patients with sepsis,again with APACHE II score used to predict death by ROC curve.The area under the curve was 0.8.The more visceral organs injury,the higher mortality of patients with sepsis.The mortality rate was the highest in severe pneumonia(37.74%).Urinary tract infection was more likely to develop acute kidney impairment(62.50%).Dysfunction of blood system occurred more frequently when infection originated from digestive tract and abdominal cavity than other sites of body.Circulatory dysfunction were more common when infection occurred in digestive tract.Klebsiella pneumonia occupied the most strains in blood culture(n=8),Enterococcus faecium was the leading pathogenic bacteria in the urine culture(n=7),the positive results of Staphylococcus aureus and Enterococcus faecium detected in sputum were secondary to colonized bacteria.3)The peak age range of patients with liver abscess was 60-69 years.Male,diabetes,and hepato-biliary disease were the main risk factors for liver abscess.Most patients had fever,but the clinical manifestation of abdominal symptoms was not obvious.Albumin level was lower in patients with diabetes mellitus(p=0.032).Right hepatic lobe was infected more(74.60%)and klebsiella pneumoniae was the main pathogenic bacteria.CRP,?-GT,D-dimer and fibrinogen increased in most patients.Patients were prone to liver or blood dysfunction.Antibiotics with puncture guided by puncture could lower failure of treatment.There were significant differences in platelet count between patients admitted to hospital and recovered patients(p <0.05).Conclusions: 1)Sepsis was more common in the emergency department.The current diagnostic criterias for sepsis still exists a few flaws.The definition for sepsis emphasized more on the body's response to infection disorder and life-threatening organ dysfunction.SOFA score was better able to assess.2)APACHE II score had important value to predict the out of patients with sepsis.The more visceral injury,the higher the mortality of patients with sepsis.There were differences in organ dysfunction conditions according to different infection sites.We should be alert to the increase of gram positive bactieria.3)The risk factors of liver abscess included diabetes,biliary tract diseases,age,male,and so on.Lacking of obvious abdominal signs in the early stage contributed to misdiagnosis or delayed diagnosis of liver abscess.Right hepatic lobe was involved more than left lobe,and Klebsiella pneumoniae was the main pathogenic bacteria in pus culture.Patients were prone to have liver dysfunction or blood abnormality such as hypercoagulative state.The strategy of antibiotics treatment combined with ultrasound guided puncture was the mainstay of the treatment to improve the outcomes in liver abscess.Platelet count was significantly different before and after treatment,and was a certain predictive parameter to evaluate the prognosis of liver abscess. |
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