Progression into sepsis: an individualized process varying by the interaction of comorbidities with the underlying infection.

Autor: Sinapidis D; Department of Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece., Kosmas V; 1st Department of Internal Medicine, 'G.Gennimatas' Athens General Hospital, Athens, Greece., Vittoros V; 1st Department of Internal Medicine, Thriasio Elefsis General Hospital, Magoula, Greece., Koutelidakis IM; 2nd Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece., Pantazi A; 2nd Department of Internal Medicine, Thriasio Elefsis General Hospital, Magoula, Greece., Stefos A; Department of Medicine and Research Laboratory of Internal Medicine, Larissa University Hospital, University of Thessaly, Medical School, Volos, Greece., Katsaros KE; Department of Surgery, Nafplion General Hospital, Nafplio, Greece., Akinosoglou K; Department of Internal Medicine, University of Patras, Rion, Greece., Bristianou M; Department of Internal Medicine, Lamia General Hospital, Lamia, Greece., Toutouzas K; 1st Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece., Chrisofos M; 2nd Department of Urology, National and Kapodistrian University of Athens, Medical School, Athens, Greece., Giamarellos-Bourboulis EJ; 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece. egiamarel@med.uoa.gr.; 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Street, 12462, Athens, Greece. egiamarel@med.uoa.gr.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2018 May 29; Vol. 18 (1), pp. 242. Date of Electronic Publication: 2018 May 29.
DOI: 10.1186/s12879-018-3156-z
Abstrakt: Background: Development of sepsis is a process with significant variation among individuals. The precise elements of this variation need to be defined. This study was designed to define the way in which comorbidities contribute to sepsis development.
Methods: Three thousand five hundred nine patients with acute pyelonephritis (AP), community-acquired pneumonia (CAP), intraabdominal infections (IAI) or primary bacteremia (BSI) and at least two signs of the systemic inflammatory response syndrome were analyzed. The study primary endpoint was to define how comorbidities as expressed in the Charlson's comorbidity index (CCI) and the underlying type of infection contribute to development of organ dysfunction. The precise comorbidities that mediate sepsis development and risk for death among 18 comorbidities recorded were the secondary study endpoints.
Results: CCI more than 2 had an odds ratio of 5.67 for sepsis progression in patients with IAI between significantly higher than AP and BSI. Forward logistic regression analysis indicated seven comorbidities that determine transition into sepsis in patients with AP, four comorbidities in CAP, six comorbidities in IAI and one in BSI. The odds ratio both for progression to sepsis and death with one comorbidity or with two and more comorbidities was greater than in the absence of comorbidities.
Conclusions: The study described how different kinds of infection vary in the degree to which they lead to sepsis. The number of comorbidities that enhances the risk of sepsis and death varies depending on the underlying infections.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje