脓毒症患者预后相关危险因素的综合分析-现代医学

脓毒症患者预后相关危险因素的综合分析

单位：1. 成都市第七人民医院重症医学科, 四川成都 610000;
2. 成都市中西医结合医院重症医学科, 四川成都 610000;
3. 成都市龙泉驿区疾病预防控制中心, 四川成都 610000

分类号：R459.7

出版年·卷·期（页码）：2023·51·第三期（294-298）

摘要：

目的：探究影响脓毒症患者预后的相关危险因素。方法：回顾性分析2019年1月至2021年12月成都市中西医结合医院重症医学科收治的208例脓毒症患者的临床数据资料。根据患者转出ICU时临床结局分为存活组(132例)和死亡组(76例)。记录两组患者的一般信息、入院24 h内生命体征和实验室检查结果的最差值；ICU住院期间是否输血、是否插管；计算24 h内急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、格拉斯哥昏迷(GCS)评分、序贯器官衰竭(SOFA)评分。对两组患者的各项指标进行单因素分析，单因素分析有统计学意义的指标进一步行多因素Logistic回归分析，筛选出脓毒症患者预后相关危险因素。对与结局存在关联的评分绘制受试者工作特征(ROC)曲线，分析各评分对脓毒症患者死亡的预测价值。结果：死亡组患者年龄、女性比例、国际标准化比值(INR)、肌酐(Cr)、C-反应蛋白(CRP)、APACHEⅡ评分、SOFA评分、进行气管插管的比例均明显高于存活组，血小板计数(PLT)、GCS评分明显低于存活组(P<0.05)。多因素Logistic回归分析显示，年龄、PLT、INR、CRP、GCS评分、APACHEⅡ评分、SOFA评分是脓毒症患者死亡的影响因素(P<0.05)。ROC曲线显示，SOFA评分预测脓毒症患者死亡的ROC曲线下面积(AUC)为0.93，明显高于APACHEⅡ评分(AUC=0.85，P=0.006 4)和GCS评分(AUC=0.79，P=0.003)结论：年龄、APACHEⅡ评分、PLT、INR、GCS评分、CRP、SOFA评分是脓毒症患者预后影响因素，SOFA评分对脓毒症患者死亡的预测价值最大，高于APACHEⅡ评分和GCS评分。

Objective：To explore the risk factors affecting the prognosis of patients with sepsis. Methods： The clinical data of 208 patients with sepsis admitted to the Department of Intensive Care Unit of Chengdu Integrated Traditional Chinese and Western Medicine Hospital from January 2019 to December 2021 were retrospectively analyzed. Patients were divided into survival group(n=132) and death group(n=76) according to the clinical outcome when they were transferred out of ICU.The general information, vital signs within 24 hours of admission and the worst value of laboratory examination results of patients in the two groups were recorded；transfusion and intubation were recorded during ICU stay;Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) score, Glasgow Coma Scale(GCS) score and Sequential Organ Failure Assessment(SOFA) score were calculated within 24 hours. Univariate analysis was performed on the indicators of the two groups, and multivariate Logistic regression analysis was performed to screen out the risk factors affecting the prognosis of patients with sepsis. Receiver operating characteristics(ROC) curve was drawn to analyze scores associated with outcome, and the predictive value of each score for death of sepsis patients was analyzed. Results： Age, female ratio, international normalized ratio(INR),creatinine(Cr),C-reactive protein(CRP), APACHEⅡ score, SOFA score, and endotracheal intubation ratio of patients in the death group were significantly higher than those in the survival group, while platelet(PLT) and GCS score were significantly lower than those in the survival group(P<0.05). Multivariate Logistic regression analysis showed that age, PLT, INR, CRP, GCS score, APACHEⅡ score, SOFA score were the prognostic factors of sepsis patients(P<0.05). ROC curve showed that the area under ROC curve(AUC) of SOFA score predicted the death of sepsis patients was 0.93, significantly higher than APACHEⅡ score(AUC=0.85, P=0.006 4) and GCS score(AUC=0.79, P=0.003). Conclusion： Age, APACHEⅡ score, PLT, INR, GCS score, CRP and SOFA score are prognostic factors in patients with sepsis.SOFA score has the highest predictive value for death in patients with sepsis, which is higher than APACHEⅡ score and GCS score.

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