血清直接胆红素对急性肺栓塞患者30天病死率的预测价值

Predictive value of serum direct bilirubin for 30-day mortality in patients with acute pulmonary embolism

目的探讨血清直接胆红素(DBIL)对急性肺栓塞(APE)患者30 d病死率的预测价值。方法纳入经CT肺动脉造影(CTPA)确诊为APE的患者369例,根据30 d内预后情况将其分为死亡组29例和生存组340例,比较两组患者的临床资料。采用多因素logistic回归分析评估APE短期不良预后的影响因素,采用受试者工作特征(ROC)曲线分析DBIL和简化急性肺栓塞严重程度指数(sPESI)评分对APE患者30 d病死率的预测价值。结果死亡组年龄、4周内手术史患者比例、脉搏、呼吸频率、sPESI评分、总胆红素(TBIL)、DBIL均高于生存组(P<0.05)。多因素logistic回归分析结果显示,呼吸频率、4周内手术史、sPESI评分、DBIL是APE患者30 d死亡的危险因素(P<0.05)。ROC曲线分析结果显示,DBIL预测APE患者30 d病死率的ROC曲线下面积(AUC)为0.783(95%CI 0.709~0.857),最佳截断值为5.25μmol/L,敏感度为82.8%,特异度为60.1%。DBIL联合sPESI评分预测APE患者30 d病死率的AUC为0.851(95%CI 0.787~0.915),敏感度为72.4%,特异度为85.2%。结论高血清DBIL与APE患者30 d高病死率相关。血清DBIL是预测APE患者30 d病死率的一项简单实用的指标,其联合sPESI评分对APE早期预警及预后判断具有重要的临床实用价值。

Objective To explore the predictive value of serum direct bilirubin(DBIL)for 30-day mortality in patients with acute pulmonary embolism(APE).Methods A total of 369 patients diagnosed with APE by CT pulmonary angiography(CTPA)were included.According to the prognosis within 30-day,they were divided into death group(29 cases)and survival group(340 cases).Clinical data between two groups were compared.Multivariate logistic regression analysis was used to evaluate the influencing factors of short-term prognosis of APE.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of DBIL and simplified acute pulmonary embolism severity index(sPESI)score on 30-day mortality in patients with APE.Results Age,proportion of patients with surgical history within 4 weeks,pulse,respiratory rate,sPESI score,total bilirubin(TBIL)and DBIL in death group were higher than those in survival group(P<0.05).Multivariate logistic regression analysis showed that respiratory rate,surgical history within 4 weeks,sPESI score and DBIL were the risk factors for 30-day death in APE patients(P<0.05).ROC curve analysis showed that area under ROC curve(AUC)of DBIL for predicting the 30-day mortality of APE patients was 0.783(95%CI 0.709~0.857),the optimal cut-off value was 5.25μmol/L,sensitivity was 82.8%,and specificity was 60.1%.AUC of DBIL combined with sPESI score for predicting the 30-day mortality of APE patients was 0.851(95%CI 0.787~0.915),sensitivity was 72.4%,and specificity was 85.2%.Conclusion High serum DBIL is associate with high 30-day mortality in patients with APE.Serum DBIL is a simple and practical clinical predictor of 30-day mortality in patients with APE and it combines with sPESI score have important clinical value for early warning and prognostic judgment of APE.