有肿瘤病史多发伤患者住院期间脓毒症发生率及危险因素:一项倾向性评分匹配研究OA
Incidence and Risk Factors of Hospital-Acquired Sepsis in Patients with Polytrauma and Malignant Tumor History:A Propensity Score Matching Study
目的:探讨具有恶性肿瘤疾病史的多发伤患者院内脓毒症的发生率及相关危险因素.方法:采用回顾性队列研究方法,连续性纳入 2019 年 11 月至 2024 年 12 月期间遂宁市中心医院经急诊收治入院的 405 例有肿瘤病史的多发伤患者作为研究对象,记录患者的一般资料、临床资料、实验室检查结果等,按照脓毒症 3.0(Sepsis 3.0)指南,以住院 28d 为观察节点,将多发伤患者分为脓毒症与非脓毒症组,计算住院期间脓毒症的发生率,对 2 组患者进行 1·1 倾向性评分匹配(propensity score matching,PSM)以均衡组间差异,采用 Logistic 回归模型分析经 PSM 后的多发伤患者住院期间发生脓毒症的独立危险因素.结果:住院期间有 127 例患者合并脓毒症,发生率为 31.36%.单因素分析显示:与未发生脓毒症患者相比,合并脓毒症患者的平均年龄和≥60 岁患者比例更高,受伤部位数更多,活动性肿瘤患者占比更高,入院 24 h 内首次急性生理与慢性健康评分、序贯器官功能衰竭评分(sequential organ fail-ure assessment,SOFA)、创伤严重程度评分更高,机械通气占比更高,白细胞计数、中性粒细胞/淋巴细胞比、血乳酸、C-反应蛋白、降钙素原(procalcitonin,PCT)明显升高;格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、红细胞(red blood cells,RBC)计数、血小板(platelets,PLT)计数明显降低;差异均有统计学意义(均 P<0.05).PSM 后,各人口学因素的影响在组间分布趋于一致(均P>0.05).多因素Logistic 回归分析显示:SOFA 评分、GCS 评分、RBC 计数、PLT计数、活动期肿瘤、PCT 是有肿瘤病史多发伤患者住院期间发生脓毒症的独立危险因素(均 P<0.05),OR 值分别为1.200、0.745、0.593、0.994、1.225、4.912.结论:SOFA 评分、GCS 评分、RBC 计数、PLT 计数、活动期肿瘤、PCT 是具有肿瘤病史多发伤患者住院期间发生脓毒症的独立危险因素,可为患者病情评估,识别脓毒症高风险人群提供参考.
Objective:To explore the incidence of sepsis and related risk factors during hospitalization in patients with polytrauma and a history of malignant tumor.Methods:A retrospective cohort study was conducted,and a total of 405 pa-tients with polytrauma admitted to Suining Central Hospital from November 2019 to December 2024 were consecutively in-cluded as study subjects,with their general information,clinical data,and laboratory test results recorded.According to the Sepsis 3.0 guidelines and with 28 days of hospitalization as the observation endpoint,patients with polytrauma were assigned to sepsis and non-sepsis groups,the incidence of sepsis was calculated,1:1 propensity score matching(PSM)was per-formed,and a logistic regression model was subsequently used to analyze the risk factors for sepsis during hospitalization after PSM.Results:127 patients developed sepsis during hospitali-zation,with an incidence of 31.36%.Univariate analysis showed that,compared with patients without sepsis,those with multiple trauma and sepsis had a higher average age,a higher proportion of patients aged≥60 years,a greater number of injured body regions,a higher proportion of patients with active tumors,higher initial acute physiology and chronic health evaluation II score,sequential organ failure assessment(SOFA)score,and injury severity score within 24 hours of admis-sion,a higher rate of mechanical ventilation,and significantly elevated blood cell count,neutrophil-to-lymphocyte ratio,lac-tate,C-reactive protein,and procalcitonin(PCT).In contrast,the Glasgow Coma Scale(GCS)score,red blood cell count(RBC),and platelet count(PLT)were significantly lower in the sepsis group.All differences were statistically significant(all P<0.05).After PSM,the distribution of demographic factors was comparable between groups(all P>0.05).Multi-variate logistic regression analysis showed that SOFA score,GCS score,RBC,PLT,active tumor,and PCT were independ-ent risk factors for sepsis during hospitalization in patients with polytrauma(all P<0.05),with OR values of 1.200,0.745,0.593,0.994,1.225,and 4.912,respectively.Conclusion:SOFA score,GCS score,RBC count,PLT count,active malignant tumor,and PCT are independent risk factors for sepsis during hospitalization in polytrauma patients.These indicators can provide evidence for evaluating clinical conditions and identifying sepsis high-risk groups among polytrauma pa-tients.
黄兆成;赵利;谢婷;房慧
629000 四川 遂宁,遂宁市中心医院 急诊医学科629000 四川 遂宁,遂宁市中心医院 急诊医学科629000 四川 遂宁,遂宁市中心医院 急诊医学科629000 四川 遂宁,遂宁市中心医院 急诊医学科
医药卫生
恶性肿瘤病史多发伤脓毒症危险因素Logistic回归模型倾向性评分匹配法
History of malignant tumorsPolytraumaSepsisRisk factorsLogistic regression modelPropensity score matching
《肿瘤预防与治疗》 2026 (5)
367-373,7
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