院内二次感染对肝硬化患者死亡风险水平的影响

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院内二次感染对肝硬化患者死亡风险水平的影响

Influence of second infection in risk of death of hospitalized patients with cirrhosis

院内二次感染对肝硬化患者死亡风险水平的影响

Influence of second infection in risk of death of hospitalized patients with cirrhosis

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doi:10.13481/j.1671-587x.20150429

吉林大学学报(医学版) ›› 2015, Vol. 41 ›› Issue (04): 820-824.doi: 10.13481/j.1671-587x.20150429

陈琳¹, 袁宏¹, 朱陇东¹, 岳伟¹, 李敏¹, 成泽怡², 李文旋²

1. 兰州大学第一医院感染科, 甘肃兰州 730000;
2. 兰州大学第一临床医学院, 甘肃兰州 730000

收稿日期:2015-02-09 发布日期:2015-08-01
通讯作者: 陈琳,主治医师,讲师(Tel:0931-8356429,E-mail:chenlin0931@126.com) E-mail:chenlin0931@126.com
作者简介:陈琳(1979-),女,重庆市人,主治医师,讲师,医学硕士,主要从事感染性疾病基础和临床方面的研究。
基金资助:
甘肃省科技厅青年科技基金资助课题 (145RJYA247)

CHEN Lin¹, YUAN Hong¹, ZHU Longdong¹, YUE Wei¹, LI Min¹, CHENG Zeyi², LI Wenxuan²

1. Department of Infectious Disease, First Hospital, Lanzhou University, Lanzhou 730000, China;
2. First Clinical Medicine College, Lanzhou University, Lanzhou 730000, China

Received:2015-02-09 Published:2015-08-01

摘要：

目的: 探讨肝硬化患者的死亡率与二次感染之间的关系,阐明二次感染对肝硬化患者死亡风险水平的影响。方法: 共纳入103例肝硬化患者,分为初次感染组(78例)和二次感染组(25例),比较2组患者的基本特征、终末期肝病模型(MELD)评分、血清白蛋白水平、感染的微生物和30 d 内的死亡率等,分析各部位感染发生率的变化,并通过多因素Logistic回归模型分析肝硬化患者死亡的危险因素。结果: 与初次感染组比较,二次感染组患者死亡率明显增加(P<0.05),肺炎和艰难梭状芽孢杆菌相关性肠炎(CDAD)的发生率明显增加(P<0.05)。多因素Logistic回归模型分析,发生二次感染(OR=4.582,P=0.000 2)、高MELD评分(OR=1.293,P<0.000 1)和低血清白蛋白(OR＝0.487,P=0.0387)是肝硬化患者死亡的独立危险因素。 结论: 院内二次感染能显著增加肝硬化患者死亡风险水平。

关键词: 感染, 肝硬化, 死亡率, Logistic 回归模型

Abstract:

Objective To investigate the relationship between the second infection and the mortality of the patients with cirrhosis, and to elucidate the influence of the second infection in the risk of death of the patients with cirrhosis. Methods A total of 103 patients with cirrhosis were enrolled and divided into first infection group (n=78) and second infection group (n=25).The basic characteristics,model for end-stage liver disease (MELD) scores,serum albumin levels,microorganisms and mortality rates in 30 d as well as the incidence of infection in parts of body of the patients in two groups were compared,and the risk factors for death in the patients with cirrhosis were analyzed by multivariate Logistic regression model. Results The mortality of the patients in second infection group was significantly higher than that in first infection group (P<0.05).The incidence of pneumonia and clostridium difficile-associated diarrhea (CDAD) of the patients in second infection group was significantly increased compared with first infection group (P<0.05).Logistic regression analysis illustrated that the higher MELD scores (OR=1.293,P<0.0001),existence of second infection (OR=4.582,P=0.0002) and lower serum albumin level (OR=0.487,P=0.0387) were the independent risk factors for the death in patients with cirrhosis. Conclusion Second infection independently increase the risk of death of the hospitalized patients with cirrhosis.

Key words: infection, cirrhosis, mortality, Logistic regression model

中图分类号:

R575.2

陈琳, 袁宏, 朱陇东, 岳伟, 李敏, 成泽怡, 李文旋. 院内二次感染对肝硬化患者死亡风险水平的影响[J]. 吉林大学学报(医学版), 2015, 41(04): 820-824.

CHEN Lin, YUAN Hong, ZHU Longdong, YUE Wei, LI Min, CHENG Zeyi, LI Wenxuan. Influence of second infection in risk of death of hospitalized patients with cirrhosis[J]. Journal of Jilin University Medicine Edition, 2015, 41(04): 820-824.

[1] 蔡均均,韩涛.2013年欧洲肝病学会肝硬化细菌感染声明的概述[J].临床肝胆病杂志,2014,30(7):588-591.

[2] Merli M,Lucidi C,Giannelli V,et al.Cirrhotic patients are at risk for health care-associated bacterial infections [J].Clin Gastroenterol Hepatol,2010,8 (11):979-985.

[3] Fernandez J,Acevedo J,Castro M,et al.Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis:a prospective study [J].Hepatology,2012,55 (5):1551-1561.

[4] Arvaniti V,D'Amico G,Fede G,et al.Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis [J].Gastroenterology,2010,139(4):1246-1256.

[5] Klevens RM,Edwards JR,Richards CLJr,et al.Estimating health care-associated infections and deaths in U.S.hospitals,2002 [J].Public Health Rep,2007,122 (2):160-166.

[6] Bajaj JS,Ananthakrishnan AN,Hafeezullah M,et al.Clostridium difficile is associated with poor outcomes in patients with cirrhosis:a national and tertiary center perspective [J].Am J Gastroenterol,2010,105 (1):106-113.

[7] Lee WL,Slutsky AS.Sepsis and endothelial permeability [J].N Engl J Med,2010,363 (7):689-691.

[8] Perencevich EN,Lautenbach E.Infection prevention and comparative effectiveness research [J].JAMA,2011,305 (14):1482-1483.

[9] Peleg AY,Hooper DC.Hospital-acquired infections due to gram-negative bacteria [J].N Engl J Med,2010,362 (19):1804-1813.

[10] Yokoe DS,Mermel LA,Anderson DJ,et al.A compendium of strategies to prevent healthcare-associated infections in acute care hospitals [J].Infect Control Hosp Epidemiol,2008,29(Suppl 1):S12-S21.

[11] Wiest R,Krag A,Gerbes A.Spontaneous bacterial peritonitis:recent guidelines and beyond [J].Gut,2012,61 (2):297-310.

[12] Chen Y,Yang F,Lu H,et al.Characterization of fecal microbial communities in patients with liver cirrhosis [J].Hepatology,2011,54 (2):562-572.

[13] Bajaj JS,Ridlon JM,Hylemon PB,et al.Linkage of gut microbiome with cognition in hepatic encephalopathy [J].Am J Physiol Gastrointest Liver Physiol, 2012,302 (1):G168-175.

[14] Teltschik Z,Wiest R,Beisner J,et al.Intestinal bacterial translocation in rats with cirrhosis is related to compromised paneth cell antimicrobial host defense [J].Hepatology,2012,55 (4):1154-1163.

[15] Koch A,Buendgens L,Dückers H,et al.Gastrointestinal bleeding in liver cirrhosis at the ICU [J].Z Gastroenterol,2013,51 (1):19-25.

[16] 许吉生,王建中,段建华.肝硬化患者感染性休克临床特征及预后[J].中华医院感染学杂志,2015,25(5):1100-1102.

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