早期IL-6、D-二聚体联合APACHE Ⅱ评分对腹腔脓毒症患者院内死亡风险评估的价值-现代医学

早期IL-6、D-二聚体联合APACHE Ⅱ评分对腹腔脓毒症患者院内死亡风险评估的价值

单位：1. 贵州医科大学临床医学院, 贵州贵阳 550001;
2. 贵阳市第一人民医院重症医学科, 贵州贵阳 550001

分类号：R495.7

出版年·卷·期（页码）：2025·53·第七期（1096-1102）

摘要：

目的：探讨IL-6、D-二聚体联合APACHE Ⅱ评分对腹腔脓毒症患者死亡风险的评估价值。方法：2020年11月—2022年3月贵阳市第一人民医院重症医学科(ICU)住院且诊断为腹腔脓毒症的成年患者92例(脓毒症组)，根据是否在院内死亡，将脓毒症组患者分为死亡亚组(37例)和生存亚组(55例)；以同期入住ICU但未诊断为脓毒症的患者作为对照组；比较两组IL-6、D-二聚体和APACHE Ⅱ评分水平， Spearman相关分析IL-6、D-二聚体与APACHE Ⅱ评分之间的相关关系； ROC曲线评估IL-6、D-二聚体和APACHE Ⅱ评分对患者院内死亡的价值。结果：脓毒症组患者IL-6(Z=-7.631，P＜0.001)、D-二聚体(Z=-4.626，P＜0.001)、APACHE Ⅱ评分(Z=-4.096，P＜0.001)均高于对照组；死亡亚组IL-6(Z=-3.106，P=0.002)、D-二聚体(Z=-5.192，P＜0.001)和APACHE Ⅱ评分(Z=-4.096，P＜0.001)高于生存亚组； IL-6(r=0.336，P=0.001)、D-二聚体(r=0.358，P＜0.001)与APACHE Ⅱ评分之间存在正相关关系；血清IL-6、D-二聚体、APACHE Ⅱ评分及三者联合预测腹腔感染的脓毒症患者院内死亡风险的AUC分别为0.692、0.793、0.752、0.820，三者联合检测优于各自单独预测效能(IL-6：Z=2.607，P=0.009；D-二聚体：Z=1.766，P=0.047；APACHE Ⅱ评分：Z=1.766，P=0.036)。结论：早期IL-6和D-二聚体水平对评估腹腔脓毒症及其死亡风险有一定价值，且三者联合检测效能优于单一指标。

Objective:To explore the diagnostic value of IL-6 and D-dimer in combination with APACHE Ⅱ score for assessing risk of death in patients with abdominal sepsis.Methods:From November 2020 to March 2022, a total of 92 adult patients with sepsis due to abdominal infection were admitted to the Intensive Care Unit(ICU) of the First People's Hospital of Guiyang and included in the study. The sepsis group was further divided into a death subgroup(37 cases) and a survival subgroup(55 cases), based on in-hospital mortality. Additionally, a control group consisting of ICU-admitted patients without sepsis during the same period was also enrolled. A comparative analysis was conducted between the two groups, focusing on IL-6 levels, D-dimer levels, and APACHE Ⅱ scores. Furthermore, Spearman correlation analysis was employed to examine the relationship among IL-6 levels, D-dimer levels, and APACHE Ⅱ scores. Finally, ROC curve analysis was performed to assess the predictive value of IL-6 levels, D-dimer levels, and APACHE Ⅱ scores for in-hospital mortality.Results: The levels of IL-6(Z=-7.631，P＜0.001), D-dimer(Z=-4.626，P＜0.001), and APACHE Ⅱ score(Z=-4.096，P＜0.001)in the sepsis group were higher than those in the control group. The levels of IL-6(Z=-3.106，P=0.002), D-dimer(Z=-5.192，P＜0.001)and APACHE Ⅱ score(Z=-4.096，P＜0.001)in the death subgroup were higher than those in the survival subgroup. There was a positive correlation between IL-6(r=0.336，P=0.001), D-dimer(r=0.358，P＜0.001)and APACHE Ⅱ score. The AUC of serum IL-6, D-dimer, APACHE Ⅱ score and the combination of the three for predicting the risk of in-hospital death in sepsis patients with intra-abdominal infection were 0.692, 0.793, 0.752 and 0.820, respectively. The combined detection of the three tests was better than each individual prediction efficiency(IL-6： Z=2.607，P=0.009；D-dimer：Z=1.766，P=0.047；APACHE Ⅱ score：Z=1.766，P=0.036). Conclusion: The levels of IL-6 and D-dimer in the early stage of patients with abdominal sepsis have certain value in evaluating abdominal sepsis and its risk of death. Moreover, the combined detection efficacy of the three is superior to that of a single indicator.

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