早期血磷情况与脓毒症患者预后的相关性

Relationship of initial serum phosphate with the mortality of the patients with sepsis

目的观察血磷水平及其变化情况与脓毒症患者预后的相关性。方法入院后分别于24h内及第5～7天进行生化全项、血磷、血气分析等检查，计算APACHEⅡ评分，以患者生存情况分组，对比不同组间血磷水平。以血磷情况为检验变量，以预后情况为状态变量，建立ROC曲线，明确患者血磷水平与患者预后相关性。结果死亡组患者血磷明显低于生存组，ROC曲线下面积为0．687（P〈0．05），血磷≥0．70mmol／L预测患者生存的可能性，敏感性为68％，特异性为65％。治疗后死亡组患者血磷明显低于生存组，ROC曲线下面积为0．747（P〈0．05）。血磷〉10．90mmol／L预测患者生存的可能性，敏感性为76％，特异性为65％。结论低磷血症对于脓毒症患者预后的评估有一定的临床意义，治疗后血磷情况相对于入院时血磷水平而言有着更好的临床预后评估意义。

Objective To determine the concentration of serum phosphate in the patients with sepsis, and to study the relationship between the serum phosphate concentration and the prognosis of patients with sepsis. Methods 39 patients （age ≥ 18 years ）with severe sepsis had serum phosphate tests on the first day and the 5th to 7th day after admission. Acute physiology and chronic health evaluation Ⅱ score was determined in the patients. Patients were divided into survival group and death group. Statistical analysis was made by the independent sample t test and ROC curve. Results The concentration of serum phosphate was lower in death group than in survival group on the first day, the area under ROC curve（AUC） was 0. 687（P 〈0.05）. Serum phosphate ≥0.70 mmol/L was used to predict survival possibility of patients, the sensitivity was 68% , and the specificity was 65%. The concentration of serum phosphate was lower in death group than in survival group on the 5th to 7th day, the area under the ROC curve （AUC） was 0. 747 （ P 〈 0.05 ）. Serum phosphate ≥ 0.90 mmol/L was used to predict survival possibility of patients, the sensitivity was 76%, and the specificity was 65%. Conclusion The concentration of serum phosphate was associated with the mortality in patients with sepsis. Concentration of serum phosphate on the 5th to 7th day was better than that on the first day to predict survival possibility of patients with sepsis.