White blood cell count trajectory and mortality in septic shock: a historical cohort study

被引：2

作者：

Rimmer, Emily ^{[1
,2
,3
]}

Garland, Allan ^{[1
,2
]}

Kumar, Anand ^{[4
,5
]}

Doucette, Steve ^{[6
]}

Houston, Brett L. ^{[2
,3
]}

Menard, Chantalle E. ^{[2
,3
]}

Leeies, Murdoch ^{[1
,2
]}

Turgeon, Alexis F. ^{[7
,8
]}

Mahmud, Salah ^{[1
]}

Houston, Donald S. ^{[2
,3
]}

Zarychanski, Ryan ^{[1
,2
,3
,4
]}

机构：

[1] Univ Manitoba, Dept Community Hlth Sci, Winnipeg, MB, Canada

[2] Univ Manitoba, Dept Internal Med, Sect Med Oncol Hematol, Winnipeg, MB, Canada

[3] CancerCare Manitoba, Dept Med Oncol & Haematol, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada

[4] Univ Manitoba, Dept Internal Med, Sect Crit Care Med, Winnipeg, MB, Canada

[5] Univ Manitoba, Dept Med Microbiol & Infect Dis, Winnipeg, MB, Canada

[6] Dalhousie Univ, Capital Dist Hlth Author, Halifax, NS, Canada

[7] Univ Laval, Trauma Emergency Crit Care Med, Populat Hlth & Optimal Hlth Practices Res Unit, CHU Quebec,Univ Laval Res Ctr, Quebec City, PQ, Canada

[8] Univ Laval, Fac Med, Dept Anesthesiol & Crit Care Med, Div Crit Care Med, Quebec City, PQ, Canada

来源：

CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE | 2022年 / 69卷 / 10期

基金：

加拿大健康研究院;

关键词：

Septic shock; trajectory analysis; white blood cell count; SEPSIS; SURVIVAL; THERAPY;

D O I：

10.1007/s12630-022-02282-5

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Purpose Septic shock is associated with a mortality of 20-40%. The white blood cell count (WBC) at hospital admission correlates with prognosis in septic shock. Here, we explore whether the trajectory of WBC after admission provides further information about outcomes. We aimed to identify groups of patients with different WBC trajectories and the association of WBC trajectory with mortality. Methods We included adult patients with septic shock in two academic intensive care units (ICU) in Winnipeg, MB, Canada between 2006 and 2012. We used group-based trajectory analysis to group patients according to their WBC patterns over the first seven days in the ICU. Our primary analysis was the association of WBC trajectory group on 30-day mortality using multivariable Cox proportional hazards regression. Results We included 917 patients with septic shock. The final model identified seven distinct WBC trajectories. The rising WBC trajectory was independently associated with increased mortality (hazard ratio, 3.41; 95% confidence interval, 1.86 to 6.26; P < 0.001) compared with the stable WBC trajectory. Conclusion In patients with septic shock, distinct and clinically relevant groups can be identified by analyzing WBC trajectories. A rising WBC trajectory was associated with higher mortality.

引用

页码：1230 / 1239

页数：10