关键词: 重症监护病房, 血流感染, 脓毒症, 流行病学, 预后

Abstract:

Objective To analyze the risk factors and predictive value of bloodstream infections (BSI) in adult sepsis patients in the intensive care unit (ICU). Methods Adult sepsis patients with BSI admitted to the ICU of Handan Central Hospital from October 2020 to October 2024 were retrospectively analyzed. Vital signs, laboratory parameters, organ dysfunction score, and treatment status within 24 hours of admission were collected. Multivariate logistic regression was used to analyze risk factors for the 28-day mortality, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of independent risk factors. Results Among 162 adult sepsis patients with BSI (92 males, 70 females) admitted to the ICU over a 4-year period, 91 died within 28 days. Univariate analysis revealed significant correlation of 28-day mortality with age, heart rate (HR), lactate (Lac), D-dimer, creatinine (Cr), mean arterial pressure (MAP), partial pressure of oxygen (PaO₂)/fraction of the inspired oxygen (FiO₂) ratio (P/F), white blood cell count (WBC), platelet count (PLT), ICU-acquired BSI proportion, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, modified Nutrition Risk in Critically Ill (mNUTRIC) score, sepsis-induced coagulopathy (SIC) score, the proportion of mechanical ventilation rate, deep vein catheterization rate, renal replacement therapy rate, and the use of vasoactive drug use >24 hours (P<0.05). Multivariate logistic regression identified that age (OR=1.070,95%CI:1.019-1.123,P=0.006), SOFA score (OR=1.301, 95%CI: 1.002-1.689, P=0.049), APACHE Ⅱ score (OR=1.179, 95%CI: 1.003-1.385, P=0.046), use of vasoactive drugs>24 hours (OR=4.125, 95%CI: 1.321-12.878, P=0.015), mNUTRIC score (OR=1.105, 95%CI: 1.007-1.206, P=0.014), P/F (OR=0.994, 95%CI: 0.989-1.000, P=0.044), and WBC (OR=0.940, 95%CI: 0.897-0.984, P=0.009) were independent prognostic factors for the 28-day mortality. ROC curve analysis showed that the area under the curve (AUC) of age, SOFA score, APACHEⅡ score, mNUTRIC score, P/F, WBC and using vasoactive drugs > 24 h in predicting the 28-day mortality was 0.655, 0.827, 0.799, 0.758, 0.330, 0.405 and 0.742, respectively, P/F and WBC had poor predictive performance. Conclusion Age, SOFA score, APACHEⅡ score, mNUTRIC score, and use of vasoactive drug use >24 hours are independent predictors of 28-day mortality in sepsis patients with BSI. The SOFA score demonstrated superior predictive performance compared to the APACHEⅡ score in predicting the 28-day mortality.

Key words: intensive care unit, bloodstream infection, sepsis, epidemiology, prognosis