Incidence of sepsis in post-craniotomy stroke patients and its impact on prognosis

doi:10.3877/cma.j.issn.2096-1537.2023.02.006

Abstract

Abstract:

Objective

To investigate the incidence of sepsis in post-craniotomy stroke patients and its impact on prognosis of patients.

Methods

This was a single-center prospective cohort study. All of the adult post-craniotomy stroke patients admitted into the intensive care unit (ICU) ward of Beijing Tiantan Hospital during study period (from January 1, 2017 to December 31, 2018) and with an ICU length of stay (LOS) longer than 24 hours were eligible. Patients with sepsis before craniotomy were excluded. Demographic and baseline clinical characteristics (age, gender, underlying disease, etc.), information about main diagnosis and surgery were collected. All patients were screened daily for presence of infection and sepsis. For patients with infection and/or sepsis, the infection sites and pathogens were recorded. All patients were followed up until discharge (alive or dead). The ICU LOS, hospital LOS, hospitalization costs, and Glasgow outcome scale (GOS) at discharge were recorded.

Results

During study period, a total of 226 patients were included, among whom 115 (50.9%) were male and 111 (49.1%) were female. The mean age was (51.6±13.6) years. Patients with hemorrhagic stroke accounted for 87.2% (n=197), and patients with ischemic stroke accounted for 12.8% (n=29). Of all patients, 122 developed infection and 76 developed sepsis. The incidence of sepsis was 33.6% (95% CI: 27.4%-39.8%). Compared with non-septic patients, septic patients had longer median ICU LOS [13 (8, 22) d vs 4 (2, 7) d, Z=7.994, P＜0.001], longer hospital LOS [27 (17, 38) d vs 17 (10, 25) d, Z=5.579, P＜0.001], and higher hospitalization costs [140 406 (100 406, 217 111) yuan vs 87 034 (60 102, 119 352) yuan, Z=6.297, P＜0.001]. Logistic regression analysis showed that sepsis was not associated with death in stroke patients after craniotomy, but sepsis was an independent risk factor for poor prognosis (GOS≤3 points) (OR=2.205, 95% CI: 1.034-4.703, P=0.041).

Conclusions

Patients have a higher risk of complicated sepsis during hospitalization after stroke craniotomy. Sepsis is not a risk factor for death during hospitalization, but can serve as an independent risk factor for poor prognosis.

Key words: Sepsis, Stroke, Post-craniotomy, Incidence, Prognosis

Jianfang Zhou, Linlin Zhang, Jianxin Zhou. Incidence of sepsis in post-craniotomy stroke patients and its impact on prognosis[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(02): 162-167.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2023.02.006

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Figures/Tables 3

变量	所有患者（226例）	脓毒症（76例）	非脓毒症（150例）	统计值	P值
年龄（岁， $x ¯$ ±s）	51.6±13.6	54.3±12.7	50.3±13.9	t=2.118	0.035
性别［例（%）］				χ²=4.259	0.039
男	115（50.9）	46（60.5）	69（46.0）
女	111（49.1）	30（39.5）	81（54.0）
吸烟［例（%）］	52（23.0）	20（26.3）	32（21.3）	χ²=0.707	0.400
饮酒［例（%）］	39（17.3）	12（15.8）	27（18.0）	χ²=0.173	0.678
入院类别［例（%）］				χ²=0.005	1.000
择期手术	142（62.8）	48（63.2）	94（62.7）
急诊手术	84（37.2）	28（36.8）	56（37.3）
既往病史［例（%）］
高血压	111（49.1）	42（55.3）	69（46.0）	χ²=1.732	0.188
糖尿病	27（11.9）	10（13.2）	17（11.3）	χ²=0.160	0.689
脑血管病	41（18.1）	13（17.1）	28（18.7）	χ²=0.083	0.774
实体肿瘤	6（2.7）	3（3.9）	3（2.0）	χ²=0.740	0.407
冠心病	12（5.3）	4（5.3）	8（5.3）	χ²=0.039	1.000
Charlson合并症指数［M（Q₂₅，Q₇₅）］	0（0，1）	0（0，1）	0（0，1）	Z=0.349	0.727
NIHSS评分［分，M（Q₂₅，Q₇₅）］	17（6，25）	14（6，24）	20（7，29）	Z=1.368	0.171
APACHE Ⅱ评分（分， $x ¯$ ±s）	17.0±6.1	19.2±5.5	15.8±6.1	t=4.056	＜0.001
ICU第1天SOFA评分［分，M（Q₂₅，Q₇₅）］	5（3，6）	6（5，7）	4（2，6）	Z=4.967	＜0.001
术后第1天GCS评分［分，M（Q₂₅，Q₇₅）］	8（5，10）	7（5，9）	8（6，11）	Z=3.424	0.001
死亡［例（%）］	31（13.7）	9（11.8）	22（14.7）	χ²=0.340	0.560
ICU住院时间［d，M（Q₂₅，Q₇₅）］	6（3，12）	13（8，22）	4（2，7）	Z=7.994	＜0.001
总住院时间［d，M（Q₂₅，Q₇₅）］	20（13，29）	27（17，38）	17（10，25）	Z=5.579	＜0.001
住院花费［元，M（Q₂₅，Q₇₅）］	101 865（69 377，150 800）	140 406（100 406，217 111）	87 034（60 102，119 352）	Z=6.297	＜0.001
出院GOS评分［分，M（Q₂₅，Q₇₅）］	3（3.0，4.0）	3（3.0，3.8）	4（3.0，4.2）	Z=3.037	＜0.001

变量	所有患者（226例）	脓毒症（76例）	非脓毒症（150例）	统计值	P值
年龄（岁， $x ¯$ ±s）	51.6±13.6	54.3±12.7	50.3±13.9	t=2.118	0.035
性别［例（%）］				χ²=4.259	0.039
男	115（50.9）	46（60.5）	69（46.0）
女	111（49.1）	30（39.5）	81（54.0）
吸烟［例（%）］	52（23.0）	20（26.3）	32（21.3）	χ²=0.707	0.400
饮酒［例（%）］	39（17.3）	12（15.8）	27（18.0）	χ²=0.173	0.678
入院类别［例（%）］				χ²=0.005	1.000
择期手术	142（62.8）	48（63.2）	94（62.7）
急诊手术	84（37.2）	28（36.8）	56（37.3）
既往病史［例（%）］
高血压	111（49.1）	42（55.3）	69（46.0）	χ²=1.732	0.188
糖尿病	27（11.9）	10（13.2）	17（11.3）	χ²=0.160	0.689
脑血管病	41（18.1）	13（17.1）	28（18.7）	χ²=0.083	0.774
实体肿瘤	6（2.7）	3（3.9）	3（2.0）	χ²=0.740	0.407
冠心病	12（5.3）	4（5.3）	8（5.3）	χ²=0.039	1.000
Charlson合并症指数［M（Q₂₅，Q₇₅）］	0（0，1）	0（0，1）	0（0，1）	Z=0.349	0.727
NIHSS评分［分，M（Q₂₅，Q₇₅）］	17（6，25）	14（6，24）	20（7，29）	Z=1.368	0.171
APACHE Ⅱ评分（分， $x ¯$ ±s）	17.0±6.1	19.2±5.5	15.8±6.1	t=4.056	＜0.001
ICU第1天SOFA评分［分，M（Q₂₅，Q₇₅）］	5（3，6）	6（5，7）	4（2，6）	Z=4.967	＜0.001
术后第1天GCS评分［分，M（Q₂₅，Q₇₅）］	8（5，10）	7（5，9）	8（6，11）	Z=3.424	0.001
死亡［例（%）］	31（13.7）	9（11.8）	22（14.7）	χ²=0.340	0.560
ICU住院时间［d，M（Q₂₅，Q₇₅）］	6（3，12）	13（8，22）	4（2，7）	Z=7.994	＜0.001
总住院时间［d，M（Q₂₅，Q₇₅）］	20（13，29）	27（17，38）	17（10，25）	Z=5.579	＜0.001
住院花费［元，M（Q₂₅，Q₇₅）］	101 865（69 377，150 800）	140 406（100 406，217 111）	87 034（60 102，119 352）	Z=6.297	＜0.001
出院GOS评分［分，M（Q₂₅，Q₇₅）］	3（3.0，4.0）	3（3.0，3.8）	4（3.0，4.2）	Z=3.037	＜0.001

变量	所有患者（226例）	脓毒症（76例）	非脓毒症（150例）	χ²值	P值
卒中类型				0.100	0.751
出血性卒中	197（87.2）	67（88.2）	130（86.7）
缺血性卒中	29（12.8）	9（11.8）	20（13.3）
卒中病因
颅内动脉瘤	90（39.8）	34（44.7）	56（37.3）	1.154	0.283
脑血管畸形	70（31.0）	21（27.6）	55（36.7）	0.598	0.439
高血压脑出血	23（10.2）	8（10.5）	15（10.0）	0.015	0.902
动脉粥样硬化	16（7.1）	6（7.9）	10（6.7）	0.116	0.734
颅内肿瘤	15（6.6）	3（3.9）	12（8.0）	1.337	0.248
抗凝或抗血小板药物	9（4.0）	4（5.3）	5（3.3）	0.491	0.489
其他	3（1.3）	0	3（2.0）	1.540	0.553

预后情况	β值	SE	OR	95% CI	χ²值	P值
死亡^a
APACHE Ⅱ	0.146	0.051	1.158	1.047~1.280	8.164	0.004
NIHSS	0.065	0.024	1.068	1.018~1.119	7.340	0.007
择期手术	-1.020	0.474	0.360	0.142~0.913	4.631	0.031
脓毒症	-	-	-	-	-	-
预后不良（GOS≤3分）^b
APACHE Ⅱ	0.184	0.044	1.202	1.103~1.311	17.529	＜0.001
NIHSS	0.059	0.021	1.061	1.018~1.105	7.888	0.005
择期手术	-0.870	0.389	0.419	0.195~0.898	5.000	0.025
脓毒症	0.791	0.386	2.205	1.034~4.703	4.189	0.041

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