Gensini评分、全身炎症指数对急性心肌梗死患者死亡事件的预测价值

The predictive value of Gensini score and systemic inflammation index for mortality in patients with acute myocardial infarction

目的本研究旨在回顾性探索急性心肌梗死(AMI)患者的Gensini评分、全身炎症指数(SII)对其随访期间出现死亡事件预后的预测价值。方法在入院时收集123例AMI患者的血液样本,观察血常规计数、血脂水平、急性心肌梗死用药情况以及合并疾病情况。采用多因素Logistic回归分析确定AMI近期院内死亡事件和随访期间死亡事件发生的危险因素,进一步通过受试者工作特征(ROC)曲线分析危险因素的对于AMI死亡事件的预测效能和预测临床结局的阈值。结果AMI死亡组在年龄、中性粒细胞计数、SII、DD二聚体、CRP、Gensini评分均高于生存组,两组间差异有统计学意义(P<0.05)。在多因素logistic回归分析可见:Gensini评分、SII是AMI患者死亡风险的独立危险因素(P<0.05)。ROC曲线分析中发现Gensini评分、SII的曲线下的最大面积分别为0.746、0.741(P<0.05),Gensini评分预测临床结局的阈值为75(灵敏度76.92%,特异性62.88%),预测临床结局的阈值为1304.21(×10^(9)/L)(灵敏度65.38%,特异性78.35%),两者联合后ROC曲线下面积进一步增加到0.847。结论Gensini评分、SII是AMI患者死亡风险的独立危险因素,两者联合可以更好地预测AMI患者死亡事件发生。

Objective This retrospective study aimed to investigate the predictive value of Gensini score and systemic inflammation index(SII)for death events in patients with acute myocardial infarction(AMI)during follow-up.Methods Blood samples were collected from 123 AMI patients upon admission.Routine blood count,blood lipid level,medication status of acute myocardial infarction and complications were observed.Multiple logistic regression analysis was conducted to identify the risk factors of recent in-hospital death of AMI and death during follow-up.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive efficacy and clinical threshold of these risk factors.Results Age,neutrophil count,SII,DD dimer,CRP and Gensini scores in AMI death group were higher than those in survival group,and the differences between the two groups were statistically significant(P<0.05).Multivariate logistic regression analysis showed that Gensini score and SII were independent risk factors for death in AMI patients(P<0.05).ROC curve analysis found that the maximum area under Gensini score and SII curve were 0.746 and 0.741 respectively(P<0.05).The threshold of Gensini score for predicting clinical outcome was 75(sensitivity 76.92%,specificity 62.88%).The predictive threshold of systemic inflammatory index for clinical outcome was 1304.21(×10^(9)/L)(sensitivity 65.38%,specificity 78.35%).After the combination of the two,the area under ROC curve further increased to AUC=0.847.Conclusion Gensini score and SII are independent risk factors of death in AMI patients,and their combination can better predict the occurrence of death in AMI patients.