创伤脓毒症多指标联合预警诊断模型的建立

Multiple predictor models for diagnosis of sepsis in trauma patients

目的利用临床常用指标，建立创伤脓毒症的联合预警诊断模型，为创伤脓毒症的早期、快速、准确诊断提供依据。方法165例创伤患者根据是否发生脓毒症分成脓毒症组（45例）和非脓毒症组（120例）。采集体温、心率、C-反应蛋白（CRP）、急性生理与慢性健康Ⅱ评分（APACHEⅡ）、感染相关的器官功能衰竭评分系统（SOFA）等指标，筛选出创伤脓毒症发生的独立预测指标，联合各独立指标构建创伤脓毒症非加权预警诊断模型（unwScore）和加权预警诊断模型（wScore）。绘制各独立预测指标及预警模型的受试者工作特征曲线（ROC），计算ROC曲线下面积（AUC）、灵敏度、特异度、阳性预测值、阴性预测值，观察各独立预测指标及联合预警诊断模型的预警诊断效果。结果体温、呼吸、心率、CRP、APACHEⅡ和SOFA在两组间的差异有统计学意义（P〈0．05），进一步多因素分析筛选出的创伤脓毒症独立预测指标有体温、CRP、APACHEⅡ评分，AUC分别为0．855、0．761、0．884，敏感度分别为0．84、0．64、0．84，特异度分别为0．78、0．80、0．82，阳性预测值分别为59．38％、55．77％、64．41％，阴性预测值分别为93．07％、85．84％、93．40％；unwScore和wScore的AUC分别为0．915、0．931，敏感度分别为0，87、0．96，特异度分别为0．85、0．78，阳性预测值分别为69．64％、63．24％，阴性预测值分别为94．50％、97．85％。结论体温、CRP、APACHEⅡ是创伤脓毒症的独立危险指标，由体温、CRP、APACHEⅡ构建的模型对创伤脓毒症有较好的预警诊断效果。

Objective To set up a warning diagnostic model by using the commonly used clinical indicators in an attempt to provide a basis for the early, fast and accurate diagnosis of posttraumatic sepsis. Methods Based on the presence of sepsis, 165 patients were grouped into sepsis group （ n = 45） and non-sepsis group （n = 120）. Body temperature, respiration, heart rate, C-reactive protein（CRP）, white blood cell, blood platelet count （PLT）, activated partial thromboplastin time （AprIT）, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score and sepsis-related organ failure assessment（SOFA） score were tested to identify the independent predictors of sepsis. Warning diagnostic models of unweighted score （unwScore） and weighted score （wScore） for posttraumatic sepsis were constructed by combining the independent variables. Receiver operation characteristic curve （ ROC ） was used to evaluate the independent predictor and warning diagnostic models for posttraumatic sepsis. Results Body temperature, respiration, heart rate, CRP, APACHE Ⅱ score and SOFA score were significantly different between the two groups（ P 〈 0. 05 ）. Multiple analysis showed body temperature, CRP and APACHE Ⅱ score were independently associated with sepsis. With the ROC analysis, areal under the curve （AUC）, sensitivity, specificity, positive predictive value and negative predictive value of unwScore （0. 915, 0. 87, 0. 85, 69.64% and 94.50% ） and wScore （0.931,0.96, 0.78, 63.24% and 97.85% ） were better than these of body temperature （0.855, O. 84, 0.78, 59.38% and 93.07% ）, CRP （0.761,0.64, 0.80, 55.77% and 85.84% ） and APACHE Ⅱ （0. 884, 0. 84, O. 82, 64.41% and 93.40% ）. Conclusions Body temperature, CRP and APACHE Ⅱ score are independent predictors of sepsis. Models combining body temperature, CRP and APACHE Ⅱ score demonstrate high performance in diagnosing sepsis in trauma patients.