脓毒症相关胆汁淤积性黄疸患者的临床特征及死亡危险因素分析

雷雨; 黎嘉嘉; 刘蓉安; 曾帆; 李贵森; 兰蕴平

doi:10.3969/j.issn.1001-5256.2020.05.023

脓毒症相关胆汁淤积性黄疸患者的临床特征及死亡危险因素分析

DOI: 10.3969/j.issn.1001-5256.2020.05.023

1. 西南医科大学附属医院肾内科
2. 四川省医学科学院.四川省人民医院重症医学中心SICU

基金项目:

四川省卫生和计划生育委员会科研课题（17PJ137）；

详细信息

中图分类号: R459.7;R575
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出版历程
- 出版日期: 2020-05-20

Clinical features of patients with sepsis-induced cholestatic jaundice and risk factors for death

Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

Research funding:

摘要

摘要:
目的观察脓毒症相关胆汁淤积性黄疸患者临床特征并分析死亡危险因素。方法收集2011年8月-2019年8月四川省医学科学院·四川省人民医院重症医学中心SICU收治的脓毒症相关胆汁淤积性黄疸患者139例,分为存活组（n=62）和死亡组（n=77）。记录患者年龄、性别、急性生理和慢性健康评分（APACHEⅡ）以及感染部位;记录5个时间点TBil、DBil、IBil、PT、国际标准化比值（INR）、AST、ALT、WBC、中性粒细胞（NEU）、降钙素原（PCT）、乳酸（Lac）数值;同时记录TBil、DBil、IBil峰值,以及血管活性药物时间、机械通气时间、人工肝血浆置换次数、重症监护病房（ICU）住院时间、Child-Pugh分级、黄疸分级。符合正态性和方差齐性的计量资料两组间比较采用独立样本t检验;不符合正态性和方差齐性的计量资料两组间比较采用Mann-WhitneyU检验。计数资料两组间比较采用χ2检验。采用二元logistic多因素回归分析进行死亡危险因素分析。结果脓毒症相关胆汁淤积性黄疸患者病死率55. 4%。存活组TBil、DBil以及IBil在14 d、21...
- 脓毒症 /
- 胆汁淤积 /
- 胆红素 /
- 危险因素
Abstract:
Objective To investigate the clinical features of patients with sepsis-induced cholestatic jaundice and the risk factors for death.Methods A retrospective analysis was performed for the clinical data of 139 patients with sepsis-induced cholestatic jaundice who were admitted to Surgical Intensive Care Unit, Critical Care Medicine Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, from August 2011 to August 2019, and the patients were divided into survival group with 62 patients and death groupwith 77 patients. Age, sex, Acute Physiology and Chronic Health Evaluation II(APACHEII) score, and infection sites were recorded; re-lated laboratory data at five time points were recorded, including total bilirubin(TBil), direct bilirubin(DBil), indirect bilirubin(IBil),prothrombin time(PT), international normalized ratio(INR), aspartate aminotransferase(AST), alanine aminotransferase(ALT), whiteblood cell count(WBC), neutrophils(NEU), procalcitonin(PCT), and lactic acid(Lac); the peak values of TBil, DBil, and IBil werealso recorded, as well as duration of use of vasoactive agent, duration of mechanical ventilation, number of times of artificial liver plasma ex-change, length of stay in the intensive care unit(ICU), Child-Pugh class, and jaundice grade. The independent samplest-test was usedfor comparison of normally distributed continuous data with homogeneity of variance between groups, and the Mann-WhitneyUtest wasused for comparison of non-normally distributed continuous data with heterogeneity of variance between groups; the chi-square test wasused for comparison of categorical data between groups; a binary logistic regression analysis was used to investigate the risk factors for death.Results The mortality rate of patients with sepsis-induced cholestatic jaundice was 55. 4%. Compared with the death group, the survivalgroup had significantly lower levels of TBil, DBil, and IBil on days 14, 21, and 28 and significantly lower peak values of TBil, DBil, andIBil(TBil:Z=-3. 230,-8. 197, and-9. 281,t=-5. 371, allP< 0. 01; DBil:Z=-4. 708,-8. 633,-9. 579, and-8. 238,P< 0. 01; IBil:Z=-2. 402,-6. 522,-8. 113, and-5. 300, allP< 0. 01). The survival group had a higher proportion of patients withmoderate jaundice, while the death group had a higher proportion of patients with severe jaundice （χ2 =57.633,P< 0. 01). Compared withthe death group, the survival group had significantly lower PT and INR at all time points(at diagnosis and on days 7, 14, 21, and 28)(PT:Z=-3. 173,-3. 467,-2. 660,-2. 261, and-3. 120, allP< 0. 05; INR:Z=-3. 141,-2. 754,-3. 230,-2. 560, and-3. 229, allP< 0. 05) and significantly lower levels of AST on days 7, 14, 21, and 28(Z=-2. 484,-3. 200,-3. 298, and-4. 277, allP< 0. 05) and ALT on days 14, 21, and 28(Z=-2. 635,-2. 667, and-4. 656, allP< 0. 01). Compared with thedeath group, the survival group had significantly lower levels of WBC and NEU on days 7, 14, and 21(WBC:Z=-3. 229,-2. 987, and-4. 537, allP< 0. 01; NEU:t =-3.332,Z=-3. 107 and-4. 485, allP< 0. 01), as well as significantly lower PCT at diagnosis andon days 14, 21, and 28(Z =-4. 844,-2. 215,-2. 869, and-7. 442, allP< 0. 05) and Lac at all time points(at diagnosis and ondays 7, 14, 21, and 28)(Z=-4. 316,-2. 913,-3. 068,-8. 578, and-9. 341, allP< 0. 01). Compared with the death group, thesurvival group had significantly shorter duration of use of vasoactive agent(Z=-6. 421,P< 0. 01), duration of mechanical ventilation(Z =-2.005,P< 0. 05), duration of artificial liver(Z =-4.822,P< 0. 01), and length of stay in the ICU(t =-3.005,P< 0. 01).TBil(odds ratio [OR] = 0. 959, 95% confidence interval [ CI]: 0. 929-0. 991,P< 0. 05), DBil( OR = 1. 056, 95% CI: 1. 009-1. 105,P< 0. 05), IBil(OR = 1. 071, 95% CI: 1. 006-1. 140,P< 0. 05), WBC on day 7(OR = 31. 365, 95% CI: 2. 878-41. 761,P< 0. 05), WBC on day 14(OR = 5. 859, 95% CI: 1. 073-31. 999,P< 0. 05), NEU on day 7(OR = 0. 007, 95% CI: 0. 003-0. 409,P< 0. 05), NEU on day 14(OR = 0. 132, 95% CI: 0. 023-0. 765,P< 0. 05), PCT at diagnosis(OR = 1. 062, 95% CI: 1. 017-1. 110,P< 0. 05), PCT on day 7(OR = 0. 920, 95% CI: 0. 855-0. 990,P< 0. 05), PCT on day 28(OR = 12. 711, 95% CI: 3. 532-45. 745,P< 0. 05), duration of use of vasoactive agent(OR =1. 657, 95% CI: 1. 337-2. 053,P<0. 05), duration of mechanical ventilation(OR =0. 783, 95% CI: 0. 634-0. 967,P<0. 05), and duration of artificial liver(OR =1. 534, 95% CI: 1. 065-2. 208,P<0. 05) were independ-ent risk factors for death in patients with sepsis-induced cholestatic jaundice.Conclusion Patients with sepsis-induced cholestatic jaundicehave a high mortality rate. The survival group has significantly lower levels and peak values of bilirubin than the death group in the middle andlate stages of the disease, and there is a higher proportion of patients with moderate jaundice in the survival group and a higher proportion of pa-tients with severe jaundice in the death group. Compared with the death group, the survival group has significantly lower degree of coagulationdisorder, levels of AST and ALT, infection indices WBC, NEU, and PCT, and perfusion index Lac. Compared with the death group, the sur-vival group has significantly better duration of use of vasoactive agent, duration of artificial liver support, duration of mechanical ventilation,and length of stay in the ICU. Bilirubin levels, infection indices WBC, NEU, and PCT, vasoactive agent, duration of mechanical ventilation,and duration of artificial liver support are independent risk factors for death in patients with sepsis-induced cholestatic jaundice.
- sepsis /
- cholestasis /
- bilirubin /
- risk factors

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