血清铁及凝血功能异常在脓毒症预后的预测价值研究

Study on the predictive value of serum iron and coagulation dysfunction in the prognosis of sepsis

目的 探讨血清铁及凝血功能异常对脓毒症预后的预测价值。方法 选取2020年1月至2022年4月温州市中心医院收治的脓毒症患者,根据患者28 d生存情况分为生存组与死亡组,对脓毒症预后的影响因素进行多因素logistic回归分析,采用ROC曲线分析血清铁及凝血功能异常对脓毒症预后的预测价值。结果 共纳入103例患者,其中男69例,女34例;生存组62例,死亡组41例。多因素logistic回归分析结果显示,SaO_(2)(%)越低(OR=0.163,95%CI:0.013~0.330,P=0.001),血清铁<2.0μmol/L(OR=0.115,95%CI:0.009~0.425,P=0.001),CRP(OR=2.986,95%CI:1.124~6.925,P=0.006)、IL-1β(OR=3.442,95%CI:1.416~7.327,P=0.003)、PT越高(OR=4.117,95%CI:1.984~5.924,P=0.004)和凝血功能异常(OR=5.788,95%CI:1.087~9.874,P=0.009)的患者,脓毒症后死亡的风险越高。ROC曲线结果显示,血清铁对脓毒症预后预测的AUC为0.847(95%CI:0.789~0.911,P=0.000),灵敏度为0.644,特异性为0.943,约登指数0.587,凝血功能异常对脓毒症预后预测的AUC为0.960(95%CI:0.951~0.992,P=0.000),灵敏度为0.793,特异度为1.000,约登指数为0.793。结论 血清铁和凝血功能异常对脓毒症预后具有较好的预测价值,可据此提前进行临床干预,以提高患者生存率。

Objective To explore the predictive value of serum iron and coagulation dysfunction on the prognosis of sepsis.Methods Patients with sepsis admitted to Wenzhou Central Hospital from January 2020 to April 2022 were selected,and were divided into survival group and death group according to their 28-day survival.The influencing factors of sepsis prognosis were analyzed by multivariate logistic regression,and the predictive value of serum iron and coagulation dysfunction on sepsis prognosis was analyzed by ROC curve.Results A total of 103 patients were included,including 69 males and 34 females.There were 62 cases in the survival group and 41 cases in the death group.Multivariate logistic regression analysis showed that the patients with lower SaO_(2)(%)(OR=0.163,95%CI:0.013-0.330,P=0.001),serum iron<2.0μmol/L(OR=0.115,95%CI:0.009-0.425,P=0.001),higher CRP(OR=2.986,95%CI:1.124-6.925,P=0.006),higher IL-1β(OR=3.442,95%CI:1.416-7.327,P=0.003),higher PT(OR=4.117,95%CI:1.984-5.924,P=0.004)and coagulation dysfunction(OR=5.788,95%CI:1.087-9.874,P=0.009)were more likely to have sepsis death.ROC curve results showed that the AUC of serum iron in predicting the prognosis of sepsis was 0.847(95%CI:0.789-0.911,P=0.000),the sensitivity was 0.644,and the specificity was 0.943,and the Youden index was 0.587.The AUC of coagulation dysfunction in predicting the prognosis of sepsis was 0.960(95%CI:0.951-0.992,P=0.000),the sensitivity was 0.793,the specificity was 1.000,and the Youden index was 0.793.Conclusions The serum iron and coagulation dysfunction have good predictive value for the prognosis of sepsis.Clinical intervention can be carried out in advance to improve the survival rate of patients.