PDF(Pubmed)
Abstract：
Early identification of the sources of infection in emergency department (ED) patients of sepsis remains challenging. Computed tomography (CT) has the potential to identify sources of infection. This retrospective study aimed to investigate the role of CT in identifying sources of infection in patients with sepsis without obvious infection foci in the ED. A retrospective chart review was conducted on patients with fever and sepsis visiting the ED of Linkou Chang Gung Memorial Hospital between July 1, 2020 and June 30, 2021. Data on patient demographics, vital signs, clinical symptoms, underlying medical conditions, laboratory results, administered interventions, length of hospital stay, and mortality outcomes were collected and analyzed. Of 218 patients included in the study, 139 (63.8%) had positive CT findings. The most common sources of infection detected by CT included liver abscesses, acute pyelonephritis, and cholangitis. Laboratory results showed that patients with positive CT findings had higher white blood cell and absolute neutrophil counts and lower hemoglobin levels. Positive blood culture results were more common in patients with positive CT findings. Additionally, the length of hospital stay was longer in the group with positive CT findings. Multivariate logistic regression analysis revealed that hemoglobin levels and positive blood culture results independently predicted positive CT findings in patients with fever or sepsis without an obvious source of infection. In patients with sepsis with an undetermined infection focus, those presenting with leukocytosis, anemia, and elevated absolute neutrophil counts tended to have positive findings on abdominal CT scans. These patients had high rates of bacteremia and longer lengths of stay. Abdominal CT remains a valuable diagnostic tool for identifying infection sources in carefully selected patients with sepsis of undetermined infection origins.
摘要：
在急诊（ED）败血症患者中早期识别感染源仍然具有挑战性。计算机断层扫描（CT）具有识别感染源的潜力。这项回顾性研究旨在探讨CT在确定无明显感染灶的脓毒症患者感染来源中的作用。对2020年7月1日至2021年6月30日期间访问林口长庚纪念医院ED的发烧和败血症患者进行了回顾性图表审查。患者人口统计数据，生命体征,临床症状,潜在的医疗状况，实验室结果,管理干预措施，住院时间,收集和分析死亡率结局.在纳入研究的218名患者中，139例（63.8%）的CT表现为阳性。CT发现的最常见感染源包括肝脓肿，急性肾盂肾炎,和胆管炎.实验室结果显示，CT表现阳性的患者白细胞和绝对中性粒细胞计数较高，血红蛋白水平较低。血培养结果阳性多见于CT表现阳性的患者。此外,CT发现阳性组的住院时间更长.多因素logistic回归分析显示，血红蛋白水平和血培养结果阳性可独立预测无明显感染源的发热或脓毒症患者的CT表现。在感染病灶未确定的脓毒症患者中，那些出现白细胞增多的人，贫血,和绝对中性粒细胞计数升高倾向于在腹部CT扫描中具有阳性结果。这些患者的菌血症发生率很高，住院时间更长。腹部CT仍然是一种有价值的诊断工具，可用于在精心选择的未确定感染起源的败血症患者中识别感染源。
