肝硬化并发肝衰竭患者发生血流感染的预后因素分析

孙朝霞; 张洁利; 倪秀莹; 杨　谦; 涂　波

文章摘要

肝硬化并发肝衰竭患者发生血流感染的预后因素分析

Analysis of prognostic factors of bloodstream infection in patients with cirrhosis and liver failure

DOI：10.3969/j.issn.1007-8134.2020.03.008

中文关键词: 肝硬化肝衰竭血流感染预后因素

英文关键词: cirrhosis liver failure bloodstream infection prognostic factor

基金项目:全军医学科技青年培育项目（14QNP109）

作者	单位
孙朝霞	潍坊市益都中心医院感染性疾病科
张洁利	中国人民解放军总医院第五医学中心感染性疾病诊疗与研究中心
倪秀莹	潍坊市益都中心医院感染性疾病科
杨　谦	潍坊市益都中心医院感染性疾病科
涂　波	中国人民解放军总医院第五医学中心感染性疾病诊疗与研究中心

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中文摘要:

目的　回顾性研究影响肝硬化并发肝衰竭患者发生血流感染的预后因素，为诊治该类患者提供循证医学证据，以期降低病死率。方法　采取回顾性研究方法，以原解放军第三〇二医院收治的肝硬化并发肝衰竭发生血流感染的124例患者为研究对象，根据随访至血流感染发生后30 d的生存情况，分为死亡组、存活组，对纳入指标进行单因素分析，将2组间差异显著的指标纳入Logistic回归分析，筛选出影响患者预后的因素。结果　入组124例患者，死亡55例。与生存组相比，死亡组女性及年龄为46～65岁患者的比例更高（P均＜0.05），且多数患者发生血流感染前终末期肝病模型（model for end-stage liver disease, MELD）评分＞25分。2组感染时血中性粒细胞比例，合并肝细胞癌、肝性脑病、急性肾功能不全、肺炎、自发性细菌性腹膜炎、脓毒性休克、12 h内应用抗生素患者的比例相比，差异均有统计学意义（P均＜0.05）。Logistic回归分析显示，46～65岁（OR=3.450，95%CI：1.042～11.420），感染前MELD评分＞25分（OR=6.949，95%CI：2.080～23.209），感染发生后＞12 h应用抗生素治疗（OR=3.142，95%CI：1.013～9.747），感染后发生脓毒性休克（OR=5.260，95%CI：1.681～16.459）的患者病死率更高（P均＜0.05）。结论　肝硬化并发肝衰竭患者一旦发生血流感染，如果年龄在46～65岁、感染前MELD评分＞25分，感染发生后＞12 h应用抗生素治疗以及感染后发生脓毒性休克，预后差。

英文摘要:

Objective　To retrospectively analyze the prognostic factors of bloodstream infection in patients with cirrhosis and liver failure and provide evidence-based medicine evidences for the diagnosis and treatment of these patients, in order to reduce mortality. Methods　A retrospective study was conducted to investigate 124 cirrhosis and liver failure patients with bloodstream infection who admitted to the former 302 Hospital of Chinese PLA. According to the survival status after the onset of bloodstream infection 30 days, the patients were divided into the death group and the survival group. The univariate analysis was performed on the included indicators, and those indicators showing significant differences between 2 groups were included in the Logistic regression analysis. Results　Among 124 patients enrolled, 55 cases died. In the death group, the percentages of female patients and patients at the age of 46-65 years old were higher than those in the survival group (P＜0.05), and most of patients had a model for end-stage liver disease (MELD) score of higher than 25 points before infection. In terms of blood neutrophil percentage upon infection, and percentages of patients complicated with hepatocellular carcinoma, hepatic encephalopathy, acute renal insufficiency, pneumonia, spontaneous bacterial peritonitis, septic shock and treated with antibiotics within 12 h, there were significant differences between 2 groups (P＜0.05). Logistic regression analysis showed that the mortality of patients at the age of 46-65 (OR=3.450, 95%CI: 1.042-11.420), with a MELD score＞25 points before infection (OR=6.949, 95%CI: 2.080-23.209), antibiotic application beyond 12 h after infection onset (OR=3.142, 95%CI: 1.013-9.747), and septic shock after infection (OR=5.260, 95%CI: 1.681-16.459) was higher (P＜0.05). Conclusions　In patients with cirrhosis and liver failure, the prognosis will be poor when the patientis at the age of 46-65, the MELD score is higher than 25 points before bloodstream infection, the antibiotic treatment is given beyond 12 h after bloodstream infection and the patient develops septic shock after bloodstream infection.

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