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Clinical Characteristics and Predictors of Mortality Differ Between Pulmonary and Abdominal Sepsis

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收录情况： ◇ SCIE

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机构： [1]Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China. [2]Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China. [3]Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China. [4]Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China [5]Department of Emergency Medicine, China-Japan Friendship Hospital, Peking Union Medical College, Beijing 100029, China. [6]Department of Emergency Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China. [7]Department of Emergency Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China. [8]Department of Emergency Medicine, The Hospital of Shunyi District Beijing, China Medical University, Beijing 101300, China. [9]Department of Emergency Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China. [10]Department of Infectious Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

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关键词： Sepsis pulmonary infection abdominal infection mortality shock

摘要：

Pulmonary and abdominal sepsis have pathophysiologically distinct phenotypes. This study aimed to compare their clinical characteristics and predictors of mortality.In this multicenter retrospective trial, 1,359 adult patients who fulfilled the Sepsis-3 criteria were enrolled and classified into the pulmonary sepsis or abdominal sepsis groups. Plasma presepsin were measured, and the scores of Acute Physiological and Chronic Health Assessment (APACHE) II, Mortality in Emergency Department Sepsis (MEDS) and Simplified Acute Physiology Score (SAPS) II were calculated at enrollment. A 28-day mortality was collected for all patients.Compared to patients with abdominal sepsis (n = 464), patients with pulmonary sepsis (n = 895) had higher 28-day mortality rate, illness severity scores, incidence of shock and acute kidney injury (AKI), and hospitalization costs. Lactate level, and APACHE II and MEDS scores were independently associated with 28-day mortality in both sepsis types. Independent predictors of 28-day mortality included PaO2/FiO2 ratio (hazard ratio [HR], 0.998; p < 0.001) and AKI (HR, 1.312; p = 0.039) in pulmonary sepsis, and SAPS II (HR, 1.037; p = 0.017) in abdominal sepsis. A model that combined APACHE II score, lactate and MEDS score or SAPS II score had the best area under the receiver operating characteristic curve in predicting mortality in patients with pulmonary sepsis or abdominal sepsis, respectively. Interaction term analysis confirmed the association between 28-day mortality and lactate, APACHE II score, MEDS score, SAPS II, and shock according to the sepsis subgroups. The mortality of patients with pulmonary sepsis was higher than that of patients with abdominal sepsis among patients without shock (32.9% vs. 8.8%; p < 0.001) but not among patients with shock (63.7 vs. 48.4%; p = 0.118).Patients with pulmonary sepsis had higher 28-day mortality than patients with abdominal sepsis. The study identified sepsis subgroup-specific mortality predictors. Shock had a larger effect on mortality in patients with abdominal sepsis than in those with pulmonary sepsis.Copyright © 2023 by the Shock Society.

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中科院(CAS)分区：

出版当年[2022]版：

大类 | 2 区医学

小类 | 2 区外科 2 区血液学 3 区外周血管病 3 区危重病医学

最新[2023]版：

大类 | 3 区医学

小类 | 3 区血液学 3 区外周血管病 3 区外科 4 区危重病医学

JCR分区：

出版当年[2021]版：

Q1 SURGERY Q2 PERIPHERAL VASCULAR DISEASE Q3 CRITICAL CARE MEDICINE Q3 HEMATOLOGY

最新[2023]版：

Q1 SURGERY Q2 CRITICAL CARE MEDICINE Q2 HEMATOLOGY Q2 PERIPHERAL VASCULAR DISEASE

影响因子： 2.7 最新[2023版] 2.8 最新五年平均 3.533 出版当年[2021版] 3.877 出版当年五年平均 3.454 出版前一年[2020版] 3.1 出版后一年[2022版]

第一作者：

第一作者机构： [1]Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

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通讯作者：

通讯机构： [1]Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China. [*1]Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Road, Beijing 100050, China

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Clinical Characteristics and Predictors of Mortality Differ Between Pulmonary and Abdominal Sepsis

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