| Objective To investigate the clinical characteristics and risk factors of death in ICU patients with sepsis in Ningxia Medical University General Hospital.Methods Using retrospective research methods,referring to the 2016 sepsis diagnostic criteria and combined with the inclusion and exclusion criteria,a total of 819 patients with sepsis were included in the ICU of Ningxia Medical University General Hospital from January 2018 to May 2022.The general epidemiological data of the patients were collected and the blood routine,liver and kidney function,coagulation function,myocardial enzyme and other indicators within 24 hours of admission to ICU were collected.The main ICU scoring system-SOFA,APACHE II,GCS,pathogenic microorganism culture results,invasive operation,CRRT and hormone use,sepsis-related complications and 28-day prognosis were collected.According to the 28-day outcome,they were divided into death group(335 cases)and survival group(484 cases).Single factor analysis was used to preliminarily screen out the risk factors related to death.Binary Logistic regression analysis was used to determine the independent risk factors for death in patients with sepsis,and the receiver operating characteristic(ROC)curve was further drawn to evaluate the value of different indicators in predicting the prognosis of patients with sepsis.All data were analyzed by SPSS26.0statistical software.Results A total of 819 patients with sepsis were included in this study,including614(74.97%)cases of septic shock.According to the 28-day outcome,335 cases were divided into the death group and 484 cases in the survival group,with a mortality rate of 40.9%.1.Clinical characteristics:(1)General information: 500 elderly patients(≥60 years old),accounting for 61.05%,with an average age of 62.55 ± 14.70 years old.There were 557males(68.01%)and 221 females(31.99%).The main causes of admission were digestive system diseases(40.17%),solid tumors(17.09%)and respiratory diseases(16.24%).78.51 % of patients with sepsis had underlying diseases,mainly including hypertension,type 2 diabetes,coronary heart disease,cancer and stroke.Patients with septic shock accounted for 74.97%,and patients with organ dysfunction≥3 accounted for 69.35%.Among the 819 patients with sepsis,619(75.58%)had received invasive mechanical ventilation,with an average mechanical ventilation duration of 5.61±7.46 days,202(24.66%)received continuous renal replacement therapy,268(32.72%)received hormone therapy,691(84.37%)underwent deep vein catheterization,and 654(79.85%)underwent arterial catheterization.The average length of ICU stay was 9.37±9.20 days,and the average total length of stay was 20.30±16.83.The most common infection site was lung(87.79%),followed by abdominal cavity(42.37%),blood flow(25.40%)and urinary system(16.48%).The pathogenic microorganisms were mainly Gram-negative bacteria(75.21%),of which Escherichia coli was the most common.(2)Differences between the death group and the survival group: 1)The age,SOFA and APACHE II within 24 hours of ICU admission,the number of organ failure > 3 in the death group were higher than those in the survival group,and the GCS score in the survival group was higher than that in the death group.The difference was statistically significant(P<0.05);the number of patients admitted to the death group due to cardiovascular system diseases and rheumatic immune system diseases was more than that in the survival group,and the number of patients admitted to the survival group due to digestive system diseases was more than that in the death group.The difference was statistically significant(P<0.05);the proportion of coronary atherosclerotic heart disease,chronic kidney disease and immune disease in the death group was higher than that in the survival group,and the difference was statistically significant(P<0.05).The proportion of septic shock,sepsis-related encephalopathy,DIC and ARDS in the death group was significantly higher than that in the survival group(P<0.05).The duration of invasive mechanical ventilation and the proportion of hormone use in the death group were greater than those in the survival group,and the difference was statistically significant(P<0.05).The proportion of pulmonary infection,urinary tract infection,bloodstream infection and the proportion of Gram-positive bacteria,Gram-negative bacteria and fungi in the death group were higher than those in the survival group,and the differences were statistically significant(P<0.05).2)In terms of laboratory indicators,bicarbonate,lactic acid,BE value,hematocrit,mean platelet volume,platelet volume distribution width,NLR,sodium ion,urea,creatinine,total bilirubin,aspartate aminotransferase,alanine aminotransferase,PT,APTT,TT,troponin,myoglobin,BNP values in the death group were higher than those in the survival group,and the difference was statistically significant(P<0.05);in addition,the PH,oxygen partial pressure,oxygenation index,hematocrit,platelet count,cholinesterase,PTA and FIB values of the survival group were higher than those of the death group,and the differences were statistically significant(P< 0.05).2.Risk factors for death:(1)Lasso regression analysis after univariate logistic regression analysis showed that age,APACHE II,GCS,septic shock,number of organ failure,oxygen partial pressure,oxygenation index,lactic acid,BE value,hematocrit,PDW,urea,creatinine,APTT,FIB,TT 16 factors are related factors affecting the death of sepsis patients.(2)Binary logistic regression analysis showed that age,septic shock,APTT,urea,creatinine,oxygenation index,lactic acid,number of organ failure,hematocrit were independent risk factors for death in ICU patients with sepsis(P<0.05 or P<0.01).3.The area under the ROC curve was: age(AUC=0.593),septic shock(AUC=0.601),APTT(AUC=0.554),urea(AUC=0.645),creatinine(AUC=0.589),oxygenation index(AUC=0.357),lactic acid(AUC=0.677),number of organ failure(AUC=0.712),hematocrit(AUC=0.419);the optimal cut-off values were: age 62.5 years,APTT 50.7s,urea10.425 mmol/L,creatinine 127.05umol/L,oxygenation index 47.9,lactic acid 3.05mmol/L,hematocrit 43.25%.Univariate logistic regression analysis showed that the number of organ failure=2(OR=1.833,P=0.060),the number of organ failure=3(OR=2.433,P=0.003),the number of organ failure=4(OR=4.440,P<0.01),the number of organ failure≥5(OR=9.753,P<0.01).Conclusion 1.The majority of ICU sepsis patients in Ningxia Medical University General Hospital are middle-aged and elderly,and the mortality rate is high.The most common site of infection is the lung.The pathogenic microorganisms are mainly Gram-negative bacteria,and the proportion of fungal infection is also high.2.Age,septic shock,APTT,urea,creatinine,oxygenation index,lactic acid,number of organ failure,and hematocrit were independent risk factors for death in ICU patients with sepsis.Among them,the number of organ failure,urea and lactic acid had better predictive efficacy. |
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