转出重症监护病房的多发伤谵妄患者血清S100B水平对其临床预后的预测价值

Predictive value of serum SIOOB levels in patients with multiple trauma combined delirium for their outcome at intensive care unit discharge

目的探讨转出重症监护病房（ICU）前升高的血清SIOOB水平对多发伤合并谵妄的患者临床预后的预测价值。方法选取江苏大学附属人民医院重症医学科2013年1月至2016年12月入住超过48h诊断为谵妄的多发伤患者179例，根据转出ICU前血清SIOOB水平高低将患者分为2组：高S100B组（i〉0．20μg／L，53例）和低S100B组（〈0．20μg/L，126例）。评估两组患者临床预后的差异。以t检验或）（。检验对组间数据进行统计学比较。结果高S100B组患者有更高的再入住ICU率（18．9％比6．3％，x2=6．464，P=0．011），其30d病死率亦高于低S100B组（5．7％比4．0％，x2=0．308，P=0．579），不良结局发生率也明显高于低S100B组（35．8％比17．5％，x2=7．144，P=0．008）。转出ICU前高SIOOB组患者序贯器官功能衰竭评分（SOFA）显著高于低S100B组（3．2±1．3比2．4±1．1，t=4．204，P=0．000）。高S100B组ICU入住时间显著长于低S100B组[（16±8）比（12±5）d，t=4．095，P=0．000]。S100B的受试者工作特征曲线下面积（AUC）为0．742，95％CI为0．574-0．910。多元logistic回归分析发现，转出ICU前S100B水平预测不良结局的比值比（95％CI）为1．39（1．15～1．53），P=0．009。结论转出ICU前的多发伤合并谵妄患者升高的血清S100B水平与临床预后不良密切相关，但升高的血清S100B水平仅是一个中等程度的预测因子，可能不能单独用于患者临床治疗决策。

Objective To investigate the predictive value of elevated serum S100B level in patients with multiple traumas combined delirium for the clinical prognosis prior to intensive care unit （ICU） discharge. Methods One hundred seventy-nine patients with multiple traumas diagnosed as delirium after admission over 48 hours to the Department of Critical Care Medicine, People＇s Hospital Affiliated to Jiangsu University from January 2013 to December 2016 were divided into two groups according to the level of serum SIOOB measured prior to the ICU discharge： high S100B group （ t〉0. 20 μ/L, n = 53） and low SIOOB group （ 〈 0. 20 μg/L, n = 126 ）. The difference of the clinical prognoses between the two groups was evaluated with t or Chi-square test. Results The patients in high SIOOB group had a higher ICU readmission rate （ 18.9% vs 6. 3%, x2 =6. 464, P =0. 011）. The 30-day mortality was higher for patients in high S100B group than that in low S100B group （5.7% vs 4.0%, X2 =0.308, P=0.579）. The incidence of adverse outcome was also significantly higher for patients in high S100B group than that in low S100B group （35.8% vs 17.5% , X2 = 7. 144, P = 0. 008） . The sequential organ failure assessment （SOFA） score before ICU discharge was also higher for patients in the high SIOOB group than that in the low S100B group （3.2 ± 1.3 vs 2. 4 ± 1.1, t =4. 204, P =0. 000）. The duration of ICU stay for patients in high S100B group was significantly longer than that in the low S100B group[ （ 16 ± 8） vs （ 12 ±5） d, t = 4. 095, P =0. 000]. The area under the curve （AUC） of receiver operating characteristics of the S100B was 0. 742, 95% CI： 0. 57± 0. 910. The multivariate logistic regression analysis revealed that the odds ratio （95% CI） in the prediction of adverse outcomes by S100B level prior to the ICU discharge was 1.39（ 1. 15 - 1.53 ）, P = 0. 009. Conclusion Elevated serum level of S100B in patients with multiple traumas combined delirium prior to ICU discharge is closely associated with poor clinical prognosis, but it is only a modest predictor that may not be used alone in judgements of clinical treatments for patients.