查尔森合并症指数联合血浆凝溶胶蛋白水平预测脓毒症患者的死亡风险

Combination of weighted index of comorbidities and gelsolin level in death risk evaluation of septic patients

目的：应用查尔森合并症指数（ WIC）联合血浆凝溶胶蛋白（ gelsolin， GSN）水平预测脓毒症患者28 d死亡风险。方法收集2012－01-2014－06我院ICU收治的112例脓毒症患者作为研究对象，回顾性收集患者一般资料、既往基础疾病、28 d预后、出院转归和住院天数等信息资料。分别于入院当天、第7天、第14天、第28天采集患者外周静脉血，采用酶联免疫吸附双抗体夹心法检测血浆凝溶胶蛋白水平，计算患者入院时WIC评分。比较不同预后患者的临床资料，采用多因素Logistic回归模型，分析WIC评分、血浆凝溶胶蛋白水平等变量与患者预后结局之间的关系，并绘制受试者工作特征（ ROC）曲线预测患者的预后。结果共纳入112例符合条件的脓毒症患者，28 d时存活82例（73．2％），死亡30例（26．8％）。脓毒症死亡患者的平均年龄、APACHEⅡ评分、WIC评分、严重脓毒症比例均高于存活组患者，血浆凝溶胶蛋白的初值和终值均低于对照组（ P＜0．001）；死亡组患者的致病因素中，肺部感染所占比例较高，其次为腹腔感染；存活组患者多发伤最多，其次为肺部感染。多因素Logistic回归分析显示，年龄、APACHEⅡ评分、WIC评分、凝溶胶蛋白初值、凝溶胶蛋白终值、严重脓毒症与患者28 d预后独立相关（ P＜0.05）。ROC曲线显示，WIC评分、凝溶胶蛋白初值、凝溶胶蛋白终值及三者合并预测概率的曲线下面积[AUC（95％CI）]依次为0．780（0．722-0．836）、0．785（0．729-0．841）、0．852（0．803-0.900）、0.889（0．847-0.931）。结论 WIC评分联合血浆凝溶胶蛋白水平可以较好地预测脓毒症患者28 d预后。

Objective To investigate the efficiency of original diseases by the Charlson＆#39;s weighted index of comorbidities （ WIC ） in predicting 28 -day mortality in patients with sepsis in intensive care unit （ ICU） .Methods One hundred and twelve cases of sepsis patients admitted to the ICU unit of Sichuan Provincial People＇s Hospital from January 2012 to June 2014 , were retrospectively collected the general information , previous underlying disease , 28-day prognosis , discharge outcome , number of days of hospitalization information materials . Peripheral venous blood was collected on admission day, the seventh day, fourteenth day, twenty -eighth day, by using enzyme linked immunosorbent assay for detection of plasma gelsolin levels , WIC score were calculated .Multivariate Logistic regression model was used to analyze the relationship between the outcome and prognosis of patients with WIC score , plasma gelsolin levels and other variables . And a receiver operating characteristic curve （ ROC） was plotted to predict the prognosis of the patients .Results One hundred and twelve cases of sepsis patients were enrolled in this study , 82 cases survived （73.2%）, 30 cases of death （26.8%）.Mean age, APACHEⅡ score, WIC score, severe sepsis proportion in septic death patients were higher than those in the survival group , gelsolin initial and final values were lower than the control group （P〈0.001）.The pathogenic factor in death patients with a high proportion was pulmonary infection, followed by abdominal infection;while the most popular pathogenic factor in survival patients was multiple injuries , followed by lung infection .Multivariate Logistic regression analysis showed that age, APACHEⅡ score, WIC score, gelsolin initial value, gelsolin terminal, severe sepsis were independently correlated to the 28-day prognosis of patients （ P〈0 .05 ） .ROC curve showed：area of WIC score, gelsolin initial value, gelsolin terminal and the three combined prediction probability curves of AUC （95%CI） were 0.780 （0.722-0.836）, 0.785 （0.729-0.841）, 0.852 （0.803-0.900）, 0.889 （0.847-0.931）, respectively.Conclusion The prediction of 28-day prognosis by WIC score is improved greatly with the combination of gelsolin .