目的:本研究的目的是调查重症监护病房(ICU)收治的成年人的严重中枢神经系统感染(CNSI)。我们分析了临床表现,原因,以及这些感染的结果,同时还确定了与住院死亡率较高相关的因素。
方法:我们在里约热内卢进行了一项回顾性多中心研究,巴西,从2012年到2019年。使用预测工具,我们选择了疑似患有CNSI的ICU患者,并回顾了他们的医疗记录.多变量分析确定了与住院死亡率相关的变量。
结果:在451名CNSI患者中,69人(15.3%)在中位住院11天(5-25IQR)后死亡。病例分布如下:29例(6.4%)有脑脓肿,161人(35.7%)患有脑炎,261人(57.8%)患有脑膜炎。特征:平均年龄41岁(27-53IQR),260(58%)男性,和77(17%)艾滋病毒阳性。脑炎的独立死亡率预测因子为AIDS(OR=4.3,p=0.01),ECOG功能容量限制(OR=4.0,p<0.01),病房ICU入院(OR=4.0,p<0.01),机械通气≥10天(OR=6.1,p=0.04),SAPS3≥55分(OR=3.2,p=0.02)。脑膜炎:年龄>60岁(OR=234.2,p=0.04),治疗延迟>3天(OR=2.9,p=0.04),机械通气≥10天(OR=254.3,p=0.04),SOFA>3分(OR=2.7,p=0.03)。脑脓肿:在多元回归中没有发现相关因素。
结论:患者的整体健康,及时治疗,感染严重程度,ICU中长时间的呼吸支持均显著影响院内死亡率.此外,使用所使用的预测工具实施CNSI监测可以增强公共卫生政策.
The goal of this
study was to investigate severe central nervous system infections (CNSI) in adults admitted to the intensive care unit (ICU). We analyzed the clinical presentation, causes, and outcomes of these infections, while also identifying factors linked to higher in-hospital mortality rates.
We conducted a retrospective multicenter
study in Rio de Janeiro, Brazil, from 2012 to 2019. Using a prediction tool, we selected ICU patients suspected of having CNSI and reviewed their medical records. Multivariate analyses identified variables associated with in-hospital mortality.
In a cohort of 451 CNSI patients, 69 (15.3%) died after a median 11-day hospitalization (5-25 IQR). The distribution of cases was as follows: 29 (6.4%) had brain abscess, 161 (35.7%) had encephalitis, and 261 (57.8%) had meningitis. Characteristics: median age 41 years (27-53 IQR), 260 (58%) male, and 77 (17%) HIV positive. The independent mortality predictors for encephalitis were AIDS (OR = 4.3, p = 0.01), ECOG functional capacity limitation (OR = 4.0, p < 0.01), ICU admission from ward (OR = 4.0, p < 0.01), mechanical ventilation ≥10 days (OR = 6.1, p = 0.04), SAPS 3 ≥ 55 points (OR = 3.2, p = 0.02). Meningitis: Age > 60 years (OR = 234.2, p = 0.04), delay >3 days for treatment (OR = 2.9, p = 0.04), mechanical ventilation ≥10 days (OR = 254.3, p = 0.04), SOFA >3 points (OR = 2.7, p = 0.03). Brain abscess: No associated factors found in multivariate regression.
Patients\' overall health, prompt treatment, infection severity, and prolonged respiratory support in the ICU all significantly affect in-hospital mortality rates. Additionally, the implementation of CNSI surveillance with the used prediction tool could enhance public health policies.