Abstract：
BACKGROUND: Sepsis is the most common cause of death in hospitals, and intra-abdominal infection (IAI) accounts for a large portion of the causes of sepsis. We investigated the clinical outcomes and factors influencing mortality of patients with sepsis due to IAI.
METHODS: This post-hoc analysis of a prospective cohort study included 2126 patients with sepsis who visited 16 tertiary care hospitals in Korea (September 2019-February 2020). The analysis included 219 patients aged > 19 years who were admitted to intensive care units owing to sepsis caused by IAI.
RESULTS: The incidence of septic shock was 47% and was significantly higher in the non-survivor group (58.7% vs 42.3%, p = 0.028). The overall 28-day mortality was 28.8%. In multivariable logistic regression, after adjusting for age, sex, Charlson Comorbidity Index, and lactic acid, only coagulation dysfunction (odds ratio: 2.78 [1.47-5.23], p = 0.001) was independently associated, and after adjusting for each risk factor, only simplified acute physiology score III (SAPS 3) (p < 0.001) and continuous renal replacement therapy (CRRT) (p < 0.001) were independently associated with higher 28-day mortality.
CONCLUSIONS: The SAPS 3 score and acute kidney injury with CRRT were independently associated with increased 28-day mortality. Additional support may be needed in patients with coagulopathy than in those with other organ dysfunctions due to IAI because patients with coagulopathy had worse prognosis.
METHODS: This post-hoc analysis of a prospective cohort study included 2126 patients with sepsis who visited 16 tertiary care hospitals in Korea (September 2019-February 2020). The analysis included 219 patients aged > 19 years who were admitted to intensive care units owing to sepsis caused by IAI.
RESULTS: The incidence of septic shock was 47% and was significantly higher in the non-survivor group (58.7% vs 42.3%, p = 0.028). The overall 28-day mortality was 28.8%. In multivariable logistic regression, after adjusting for age, sex, Charlson Comorbidity Index, and lactic acid, only coagulation dysfunction (odds ratio: 2.78 [1.47-5.23], p = 0.001) was independently associated, and after adjusting for each risk factor, only simplified acute physiology score III (SAPS 3) (p < 0.001) and continuous renal replacement therapy (CRRT) (p < 0.001) were independently associated with higher 28-day mortality.
CONCLUSIONS: The SAPS 3 score and acute kidney injury with CRRT were independently associated with increased 28-day mortality. Additional support may be needed in patients with coagulopathy than in those with other organ dysfunctions due to IAI because patients with coagulopathy had worse prognosis.
摘要：
背景：脓毒症是医院最常见的死亡原因，和腹腔内感染（IAI）占脓毒症病因的很大一部分。我们调查了IAI引起的脓毒症患者的临床结局和影响死亡率的因素。
方法：这项前瞻性队列研究的事后分析包括2126例败血症患者，他们访问了韩国16家三级医院（2019年9月至2020年2月）。该分析包括219名年龄>19岁的患者，他们因IAI引起的败血症而进入重症监护病房。
结果：感染性休克的发生率为47％，在非幸存者组中明显更高（58.7％vs42.3％，p=0.028)。28天的总死亡率为28.8%。在多变量逻辑回归中，在调整了年龄之后，性别,Charlson合并症指数，还有乳酸,仅凝血功能障碍（比值比：2.78[1.47-5.23]，p=0.001)是独立相关的，在对每个风险因素进行调整后，只有简化急性生理学评分III(SAPS3)(p<0.001)和连续性肾脏替代治疗(CRRT)(p<0.001)与较高的28日死亡率独立相关.
结论：SAPS3评分和CRRT导致的急性肾损伤与28天死亡率增加独立相关。与IAI引起的其他器官功能障碍患者相比，凝血病患者可能需要额外的支持，因为凝血病患者的预后较差。
方法：这项前瞻性队列研究的事后分析包括2126例败血症患者，他们访问了韩国16家三级医院（2019年9月至2020年2月）。该分析包括219名年龄>19岁的患者，他们因IAI引起的败血症而进入重症监护病房。
结果：感染性休克的发生率为47％，在非幸存者组中明显更高（58.7％vs42.3％，p=0.028)。28天的总死亡率为28.8%。在多变量逻辑回归中，在调整了年龄之后，性别,Charlson合并症指数，还有乳酸,仅凝血功能障碍（比值比：2.78[1.47-5.23]，p=0.001)是独立相关的，在对每个风险因素进行调整后，只有简化急性生理学评分III(SAPS3)(p<0.001)和连续性肾脏替代治疗(CRRT)(p<0.001)与较高的28日死亡率独立相关.
结论：SAPS3评分和CRRT导致的急性肾损伤与28天死亡率增加独立相关。与IAI引起的其他器官功能障碍患者相比，凝血病患者可能需要额外的支持，因为凝血病患者的预后较差。
