不同时间的血管活性药物评分对脓毒性休克患者死亡风险的预测价值

The predictive value of vasoactive-inotropic score at different time points in the risk of death in patients with septic shock

目的评估不同时间的血管活性药物评分(vasoactive inotropic score,VIS)预测脓毒性休克患者28 d病死率的价值,以期降低患者的死亡风险、改善预后。方法为单中心回顾性队列研究,通过收集2016年2月至2020年2月徐州医科大学附属医院重症医学科收治的275例接受血管活性药物治疗的成人脓毒性休克患者的临床资料,根据28 d生存情况分为死亡组和存活组,计算所有患者第1个24 h、第2个24 h最大血管活性药物评分,分别以VIS_(max24)、VIS_(max48)表示。采用多因素Logistic回归分析影响患者预后的独立危险因素,受试者工作特征曲线(ROC)对VIS的预测价值进行分析。结果死亡组和存活组在年龄、性别、体质量、感染部位、血培养结果、心脏骤停、激素的使用、24 h补液量的差异均无统计学意义(P>0.05),死亡组的VIS、急性生理与慢性健康评分(APACHEⅡ)、基础乳酸,治疗24 h时乳酸均明显升高(P<0.05)。VIS_(max24)可以准确预测28 d病死率(AUC=0.953,95%CI:0.924~0.982),较APACHEⅡ评分(AUC=0.865,95%CI:0.818~0.913)、VIS_(max48)(AUC=0.919,95%CI:0.881~0.957)、基础乳酸(AUC=0.937,95%CI:0.900~0.966)预测效能更高。结论VIS_(max24)能够更准确地预测脓毒性休克患者的28 d病死率。

Objective To evaluate the value of vasoactive-inotropic Score(VIS)at different time points in predicting the 28-day mortality of patients with septic shock,so as to reduce the risk of death and improve the prognosis of patients.Methods This experiment was a single-center retrospective cohort study.The clinical data of 275 adult patients with septic shock who were treated with vasoactive drugs in the intensive care unit of the Affiliated Hospital of Xuzhou Medical University from February 2016 to February 2020 were collected.According to the 28-day survival condition,all recruited patients were divided into the death group and the survival group,and the maximum vasoactive-inotropic score of all patients at the first 24 h and the second 24 h were calculated,which were expressed as VIS_(max24) and VIS_(max48).Multivariate logistic regression analysis was used to find the independent risk factors that influencing the prognosis.The receiver operating characteristic curve was used to analyze the predictive value of VIS.Results There was no significant difference between the death group and the survival group in the characteristics including age,sex,weight,infection sites,blood culture results,cardiac arrest,hormone use,and 24 h rehydration volume(P>0.05).APACHE II score,basic lactic acid,and lactic acid after 24 h of treatment were increased significantly in the death group(P<0.05).VIS_(max24) could accurately predict the 28-day mortality(AUC=0.953,95%CI:0.924-0.982),which were more efficent compared to VIS_(max48)(AUC=0.919,95%CI:0.881-0.957),basic lactic acid(AUC=0.937,95%CI:0.900-0.966)and APACHEⅡscore(AUC=0.865,95%CI:0.818-0.913).Conclusion VIS_(max24) can more accurate predict the 28-day mortality in patients with septic shock.