脓毒性休克患者预后不良的多指标联合预测方法研究

Forecasting methods based on combination of multiple indicators for poor prognosis in patients with septic shock

  • 摘要:
    目的 探讨简化急性生理学评分Ⅱ(SAPS-Ⅱ)、血清降钙素原(PCT)、乳酸清除率(LCR)对脓毒性休克患者预后的预测价值。
    方法 分析127例脓毒性休克患者的临床资料, 根据预后情况将其分为死亡组和存活组。比较2组SAPS-Ⅱ评分及血清PCT、LCR; 采用多因素Logistic回归模型分析影响患者预后的相关因素; 采用受试者工作特征(ROC)曲线分析上述因素对预后的预测价值。
    结果 127例脓毒性休克患者在28 d内共死亡45例,病死率为35.43%(45/127); 死亡组SAPS-Ⅱ评分,入院时及入院48 h的PCT, 入院时及入院6、48 h血乳酸均高于存活组,氧合指数及入院6、48 h的LCR均低于存活组,差异有统计学意义(P < 0.05)。多因素Logistic回归分析显示, SAPS-Ⅱ评分、入院时PCT、入院48 h PCT、入院时血乳酸、入院6 h血乳酸、入院48 h血乳酸均是脓毒性休克患者预后的危险因素(P < 0.05), 氧合指数、入院6 h LCR、入院48 h LCR均为脓毒性休克患者预后的保护因素(P < 0.05)。ROC曲线分析显示, SAPS-Ⅱ评分联合入院时PCT及入院6 h LCR、SAPS-Ⅱ评分联合入院48 h PCT及入院48 h LCR预测脓毒性休克患者预后的灵敏度和曲线下面积(AUC)分别为95.56%、0.922和97.78%、0.926, 均高于各指标单独预测的结果,差异有统计学意义(P < 0.05)。
    结论 SAPS-Ⅱ评分、入院时PCT、入院48 h PCT、入院6 h LCR、入院48 h LCR均是影响脓毒性休克患者预后的因素,且SAPS-Ⅱ评分与不同时点血清PCT和LCR联合均可提高临床中对该类患者预后的预测价值,尤其是SAPS-Ⅱ评分联合入院48 h血清指标的预测价值更高。

     

    Abstract:
    Objective To explore the values of the Simplified Acute Physiology Score Ⅱ (SAPS-Ⅱ), serum procalcitonin (PCT) and lactate clearance rate (LCR) in predicting the prognosis of patients with septic shock.
    Methods The clinical materials of 127 patients with septic shock were analyzed, and the patients were divided into death group and survival group according to the prognosis. The SAPS-Ⅱ, serum PCT and LCR were compared between the two groups; a multivariate Logistic regression model was used to analyze the relevant factors affecting prognosis of patients; the receiver operating characteristic (ROC) curve was used to analyze the values of the above factors in predicting prognosis.
    Results In the 127 patients with septic shock, 45 cases died within 28 days, with a mortality rate of 35.43% (45/127); the SAPS-Ⅱ score, PCT levels at admission and 48 hours after admission, and blood lactate levels at admission and 6 and 48 hours after admission in the death group were significantly higher than those in the survival group, while the oxygenation index and LCR at 6 and 48 hours after admission were significantly lower than those in the survival group (P < 0.05). The multivariate Logistic regression analysis showed that SAPS-Ⅱ score, PCT at admission, PCT at 48 h after admission, blood lactate at admission, blood lactate at 6 h after admission, and blood lactate at 48 h after admission were the risk factors for the prognosis of patients with septic shock (P < 0.05), while oxygenation index, LCR at 6 h after admission, and LCR at 48 h after admission were the protective factors for the prognosis of patients with septic shock (P < 0.05). ROC curve analysis showed that the sensitivities and the area under the curve (AUC) values of SAPS-Ⅱ score combined with PCT at admission and LCR at 6 h after admission as well as SAPS-Ⅱ score combined with PCT at 48 h after admission and LCR at 48 h after admission in predicting the prognosis of patients with septic shock were 95.56%, 0.922 and 97.78%, 0.926 respectively, which were significantly higher than the those predicted by single indicator (P < 0.05).
    Conclusion The SAPS-Ⅱ score, PCT at admission, PCT at 48 h after admission, LCR at 6 h after admission and LCR at 48 h after admission are the factors affecting the prognosis of patients with septic shock. Moreover, the combination of SAPS-Ⅱ score with serum PCT and LCR at different time points can improve the predictive value of prognosis for these patients in clinical practice, especially the combination of SAPS-Ⅱ score and serum indicators at 48 h after admission has a higher predictive value.

     

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