急性胆道感染患者术后死亡危险因素分析

Risk factors for postoperative death in patients with acute biliary infection

关键词:  急性胆道感染  死亡率  Charlson合并症指数  危险因素

Key words:  acute biliary infection  mortality  Charlson comorbidity index  risk factors

摘要:

目的调查急性胆道感染术后入ICU患者的病死率，分析患者30天死亡的危险因素，探讨相关危险因素的临床意义。方法选取2015年1月—2019年12月同济大学附属同济医院重症医学科收治的急性胆道感染（急性胆囊炎、急性胆管炎）术后患者127例，分为存活组（n=106）和死亡组（n=21）。收集相关危险因素资料，经过单因素分析后，对可能有意义的因素再行多因素Logistic回归分析，寻找急性胆道感染术后入ICU患者30 d死亡的危险因素，通过ROC分析探讨这些因素对患者30 d死亡的预测价值。结果最终纳入的127例急性胆道感染术后入ICU患者的30 d病死率为16.5%。单因素分析显示存活组和死亡组在慢性肝病、慢性肾病、CCI、ApacheⅡ评分、SOFA评分、脓毒性休克以及ALT、AST、TBiL、Cr、WBC、PLT、CRP、PCT上差异存在统计学意义（P<0.05）。多因素Logistic回归分析结果显示CCI（OR=17.475，95%CI： 2.223~5.434,P=0.011）、SOFA评分（OR=2.133，95%CI： 1.126~4.041,P=0.020）、脓毒性休克（OR=32.207，95%CI： 2.223~5.454,P=0.022）、TBiL（OR=1.021，95%CI： 1.002~1.041,P=0.031）是急性胆道感染患者死亡的危险因素。CCI、SOFA评分、脓毒性休克和TBiL的ROC曲线下面积分别为0.843、0.887、0.878和0.858，而任意两个指标的预测性能差异均无统计学意义。结论脓毒性休克、CCI、SOFA评分和TBil在预测急性胆道感染术后患者死亡中有一定价值。患者存在感染性休克、高胆红素血症，CCI以及SOFA评分越高，死亡风险越高。

Abstract:

ObjectiveTo investigate the risk factors of postoperative death of patients with acute biliary infection. MethodsClinical data of 127 postoperative patients with acute biliary infections(acute cholecystitis or acute cholangitis) admitted to the Department of Critical Care Medicine, Tongji Hospital from January 2015 to December 2019 were retrospectively analyzed, including 21 cases died within 30 days after surgery(fatal group) and 106 cases survived(survival group). The risk factors for death within 30 days were analyzed with univariate and multivariate logistic regression analyses, the predictive value of these factors for postoperative death was analyzed with ROC curve. ResultsThe 30-day fatality rate of the 127 patients admitted to the ICU after the operation for acute biliary infection was 16.5%(21/127). Univariate analysis showed that there were significant differences in chronic liver disease, chronic kidney disease, Charlson comorbidity index(CCI), acute physiology and chronic health evaluation(ApacheⅡ) score, sequential organ failure assessment(SOFA) score, septic shock, and ALT, AST, TBiL, Cr, WBC, PLT, CRP, PCT between survival and fatal groups(all P<0.05). Multivariate logistic regression analysis showed that CCI score(OR=17.475,95%CI： 2.223-5.434,P=0.011), SOFA score(OR=2.133,95%CI： 1.126-4.041,P=0.020), septic shock(OR=32.207,95%CI： 2.223-5.454,P=0.022), TBiL(OR=1.021,95%CI： 1.002-1.041,P=0.031) were risk factors for 30-day death after surgery in patients with acute biliary infection. The area under the ROC curve(AUC) of CCI score, SOFA score, septic shock and TBiL were 0.843,0.887,0.878 and 0.858, respectively; there was no significant difference in the predictive performance between any two indexes. ConclusionSeptic shock, CCI score, SOFA score and TBil have certain value in predicting the death of patients after acute biliary infection surgery. Patients with septic shock, hyperbilirubinemia, high CCI and SOFA scores have high risk of 30-day death.