老年脓毒症患者预后相关因素的探讨

Prognostic factors in elderly patients with sepsis

目的:探讨老年脓毒症患者预后的相关因素。方法:检测139例老年脓毒症患者入院时静脉血C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体(D-D)和动脉血乳酸(LAC),并分别记录24 h的急诊脓毒症病死率(MEDS)评分、急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分。根据28 d的转归,将139例脓毒症患者分为存活组80例和死亡组59例,比较上述指标在2组间有无统计学差异。采用多因素logistic回归分析筛选预测死亡的危险因素,应用受试者工作特征曲线(ROC曲线)比较危险因素的预测能力。结果:2组比较,上述指标均有统计学意义。而多因素logistic回归分析发现CRP(OR=1.041,P=0.342)、PCT(OR=0.999,P=0.898)不是预测死亡的危险因素;D-D(OR=1.050,P=0.047)、LAC水平(OR=1.529,P=0.014)、MEDS评分(OR=1.180,P=0.012)和APACHEⅡ评分(OR=1.103,P=0.036)是预测死亡的危险因素。D-D、LAC水平、MEDS评分和APACHEⅡ评分的ROC曲线下面积(AUC)分别为0.643、0.806、0.828、0.831,APACHEⅡ评分比较曲线下面积(AUC),LAC水平、MEDS评分,差异无统计学意义(P>0.05)。结论:MEDS评分、LAC水平、D-D是预测老年脓毒症患者死亡的风险因素,MEDS评分和LAC水平预测能力与APACHEⅡ评分相当。

Objective： To investigate the factors related to the prognosis of elderly patients with sepsis. Methods： In 139 elderly patients admitted to the emergency rescue room and intensive care unit（ ICU） of Beijing Hospital from July 2014 to July 2015,blood C-reactive protein（ CRP）,procalcitonin（ PCT）,D-Dimer and artery lactate（ LAC） at admission were determined. The mortality in emergency department sepsis（ MEDS） score and acute physiology and chronic health evaluationⅡ（ APACHE Ⅱ） score were estimated within 24 h. According to the survival outcome at 28 th day,139 patients were divided into two groups： survival group（ n = 80 cases） and death group（ n = 59 cases）. The above indexes were statistically compared. Multivariate logistic regression analysis was used to screen risk factors for the prediction of death. The receiver operating characteristic（ ROC） curve was used to compare the predictive ability of the risk factors. Results： There were significant differences in the above indexes between two groups. Multivariate logistic regression analysis revealed that CRP（ OR = 1.041,P = 0.342） and PCT（ OR = 0.999,P = 0.898） were not risk factors of predicting death,and D- dimer（ OR = 1.050,P = 0.047）,artery lactate（ OR = 1.529,P = 0.014）,MEDS score（ OR = 1.180,P = 0.012） and APACHEⅡ score（ OR = 1.103,P = 0.036） were risk factors of predicting death. The area under curve（ AUC） of ROC about D-dimer,artery lactate,MEDS score and APACHEⅡ score was respectively 0.643,0.806,0.828 and 0.831. There was no significant difference in the AUC of ROC about the APACHEⅡ score,artery lactate and MEDS score between two groups. Conclusion： MEDS score,artery lactate and D-dimer were risk factors for predicting death of elderly patients with sepsis. The prediction ability of MEDS score and artery lactate were equivalent to APACHEⅡ score.