危重患者血清肌酸激酶水平与死亡风险的相关性

Correlation of creatine kinase changes with mortality risk in the patients with critical illness

目的探讨急诊收治的危重患者入院24h内血清肌酸激酶（CK）水平与病情严重程度（死亡风险）的相关性。方法统计急诊监护室（EICU）内2008—01—2009—12收治的各种危重患者229例，均于急诊24h内检测CK水平，同时参照急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）评估疾病严重程度，进行对照分析。运用受试者工作特征（ROC）曲线，以CK为检验变量，以28d死亡／存活出院为状态变量，计算曲线下面积（AUC），评估其预测死亡风险的准确度，并分析CK与APACHEII评分联合应用时的评估价值。结果死亡组CK水平显著高于存活组（P〈0．05）。CK水平高于200U／L时，CK水平与APACHEⅡ评分呈正相关（r=0．392，P=0．003）。CK和APACHEⅡ评分的AUC分别为0．815和0．880。以Youden指数（灵敏度＋特异度一1）最高时的数值作为界值（cutoffvalue），CK的界值为215U／L，预测死亡的灵敏度为79．5％，特异度为78．1％；APACHEⅡ评分的界值为17分，预测死亡的灵敏度为89．7％，特异度为74．7％。二者联合诊断试验结果：平行诊断试验灵敏度为97．4％，特异度为66．8％；系列诊断试验灵敏度为69．2％，特异度为88．4％。结论危重患者急诊24h内血清CK水平的升高与死亡风险的增加呈正相关，早期CK与APACHEII评分联合应用可提高对病情严重程度评估的准确性。

Objective To investigate the role of ereatine kinase （CK） in predicting 28 - clay mortality of critically ill patients in Emergency Intensive Care Unit （EICU）. Methods A total of 229 critically ill patients admitted in EICU were enrollod and blood sample was obtained for serum CK measurement from each patient in the first 24h after they reached emergency room. Patients＇ severity of illness was assessed by Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ score. Predictive value, in terms of EICU mortality within 28 days, was analyzed by receiver operating characteristics （ROC） statistics and described by the area under the curve （AUC）. Results 39 patients died during the 28 - day observation period. The first - 24 h CK levels of the dead were significantly higher than those of the survivals （P 〈 0. 05 ）. Among the patients whose CK level was higher than 200 U/L, CK levels were positively correlated with APACHE Ⅱ scores （ r = 0. 392, P = 0. 003）. With respect to EICU mortality, AUCs were 0. 815 for CK and 0. 880 for APACHE 11. The optimum cutoff value for predicting severity by CK was 215 U/L, which gave a sensitivity and specificity of 0. 795 and 0. 781 respectively. Comparatively, the optimum cutoff value by APACHE Ⅱ was 17, which gave a sensitivity and specificity of 0. 897 and 0. 747 respectively. CK combined with APACHE Ⅱ in a parallel test increased the sensitivity to 97.4%, while in a serial test increased the specificity to 88.4%. Conclusion Serum CK level during the first 24 h after their visiting hospital is a significant predictor of 28 - dax mortality in eriheally ill patients in EICU. CK eomhined with APAC14EⅡ can predict the mortality risk more effectively.