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摘要：
目的 回顾性分析ICU中脓毒症休克患者持续炎症‑免疫抑制‑分解代谢综合征（persistent inflammation, immunosuppression and catabolism syndrome, PICS）的危险因素及其对预后的影响。 方法 纳入2018年7月至2023年1月在苏州大学第一附属医院中心ICU收治的116例脓毒症休克患者。根据是否发生PICS将患者分为两组：非PICS组（85例）和PICS组（31例）。收集两组患者的基本资料［年龄、性别、病史、实验室参数、观察指标、治疗、急性生理与慢性健康（Acute Physiology and Chronic Health Evaluation, APACHE Ⅱ）评分、快速序贯器官衰竭（quick Sequential Organ Failure Assessment, qSOFA）评分及序贯器官衰竭（Sequential Organ Failure Assessment, SOFA）评分］、临床轨迹［慢性危重病（chronic critical illness, CCI）、快速恢复（rapid recovery, RR）以及14 d内死亡情况］、ICU住院时间及ICU外住院时间。对导致患者合并PICS的危险因素进行单因素logistic回归分析，对以上具有统计学意义的变量进行多因素logistic回归分析。采用Kaplan‑Meier曲线评估脓毒症休克患者合并PICS对其28 d住院生存率的影响。 结果 两组患者恶性肿瘤、白蛋白、前白蛋白、C反应蛋白、淋巴细胞计数、活化部分凝血活酶时间、ICU获得性高钠血症、正常血钠、谵妄、热峰、革兰阴性菌感染、ICU住院时间、CCI、RR以及14 d内死亡情况等比较，差异有统计学意义（P<0.05），其他指标差异无统计学意义（P>0.05）。谵妄［比值比（odds ratio, OR）7.22，95%CI 1.64~31.89，P=0.009］是PICS的独立危险因素。PICS与患者28 d生存率有显著相关性（P=0.001）。 结论 谵妄是预测脓毒症休克患者PICS的独立危险因素，PICS可导致脓毒症休克患者更高的28 d内病死率，因此谵妄可作为脓毒症休克治疗中潜在的预测指标。
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Abstract: Objective To retrospectively analyze the risk factors of persistent inflammation, immunosuppression and catabolism syndrome (PICS) in patients with septic shock and its impact on prognosis at intensive care unit (ICU). Methods A total of 116 septic shock patients who were admitted to the central ICU of the First Affiliated Hospital of Soochow University from July 2018 to January 2023 were enrolled. According to the occurrence of PICS, the patients were divided into two groups: a non‑PICS group (n=85) and a PICS group (n=31). Their basic data [Age, sex, medical history, laboratory parameters, observation index, treatment, Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ) score, quick Sequential Organ Failure Assessment (qSOFA) score and Sequential Organ Failure Assessment (SOFA) score], clinical development [chronic critical illness (CCI), rapid recovery (RR), and mortality within 14 d], length of ICU stay and length of hospitalization stay outside ICU were collected. Univariate logistic regression analysis was conducted for screening the risk factors causing PICS. The resultant variables with statistical significance were applied for multivariate logistic regression analysis. Kaplan‑Meier curve was plotted to evaluate the effect of PICS on 28‑day survival rate of septic shock patients. Results There were statistical differences in malignant tumor, albumin, prealbumin, C‑reactive protein, lymphocyte count, activated partial thromboplastin time, ICU acquired hypernatremia, normal blood sodium, delirium, heat peak, gram‑negative bacterial infection, the length of ICU stay, CCI, RR and mortality within 14 d between the two groups (P<0.05). There was no statistical difference in other indexes (P>0.05). Delirium [odds ratio (OR) 7.22, (95% confidence interval (CI) 1.64, 31.89), P=0.009] was the independent risk factor for PICS. Moreover, PICS was significantly correlated with 28‑day survival rate (P=0.001). Conclusions Delirium is an independent risk factor for PICS. PICS can lead to higher 28‑day mortality, which may therefore be a potential predictor for the treatment of septic shock.
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