入重症监护室早期肌钙蛋白Ⅰ水平对非心脏手术重症患者预后的预测价值

Prognostic Value of Initial Troponin Ⅰ Level in Non-cardiac Surgery Critically Ill Patients at Intensive Care Unit

目的:评估入外科重症监护室(ICU)早期肌钙蛋白I(TnⅠ)水平对非心脏手术重症患者预后的预测价值。方法:连续观察2015-01-01至2015-12-31入住我院外科ICU的非心脏手术重症患者,检测其入ICU早期TnⅠ水平;比较入ICU早期TnⅠ升高患者与TnⅠ正常患者一般临床资料、既往病史、急性生理与慢性健康(APACHE)Ⅱ评分、死亡率,比较存活者与死亡者的入ICU早期TnⅠ水平、一般临床资料、既往病史、APACHEⅡ评分等指标;采用多因素回归分析非心脏手术重症患者ICU死亡的危险因素;采用受试者工作特征(ROC)曲线评价入ICU早期TnⅠ水平及APACHEⅡ评分对ICU死亡的预测价值。结果:共入选1 193例患者,其中159例(13.3%)入ICU早期TnⅠ水平升高。入ICU早期TnⅠ升高患者的APACHEⅡ评分显著高于TnⅠ正常的患者[17.0(14.0,21.0)分vs 15.0(13.0,18.0)分],前者死亡率也高于后者(18.2%vs 2.6%),差异均有统计学意义(P均=0.000)。对死亡者(n=56)与存活者(n=1 137)进行单因素比较和多因素回归分析后发现,年龄(OR=1.041)、APACHEⅡ评分(OR=1.218)、入ICU早期TnⅠ水平(OR=6.366)为非心脏手术重症患者ICU死亡的独立危险因素(P均<0.05)。ROC曲线分析显示,入ICU早期TnⅠ水平及APACHEⅡ评分预测ICU死亡的曲线下面积分别为0.763和0.778,两者联合曲线下面积为0.803。结论:入ICU早期TnⅠ升高是非心脏手术重症患者ICU死亡的独立危险因素,对死亡具有预测价值。

Objective：To evaluate the prognostic value of initial troponin I（TnⅠ） level in non-cardiac surgery critically ill patients at surgical intensive care unit（ICU）.Methods：We consecutively observed non-cardiac surgery critically ill patients admitted in surgical ICU of our hospital from 2015-01-01 to 2015-12-31.TnⅠ level was measured at the early ICU admission,general clinical data,previous history,acute physiology and chronic health evaluation（APACHE） II score and mortality were compared between the patients with elevated TnⅠ and normal TnⅠ;TnⅠ level at the early ICU admission,general clinical data,previous history and APACHE II score were compared between survival patients and deceased patients.Risk factors for ICU mortality were studied by multivariable regression analysis;predictive values for initial TnⅠ level and APACHE II score in mortality were assessed by receiver operating curve（ROC）.Results：A total of 1 193 patients were enrolled and 159（13.3%） of them had TnⅠ elevation upon ICU admission.Compared with normal TnⅠ patients,TnⅠ elevated patients had the higher APACHE II score [17.0（14.0-21.0） vs 15.0（13.0-18.0）] and ICU mortality（18.2% vs 2.6%）,both P=0.000.There were 56 patients died and 1 137 survived,single and multivariable regression analysis indicated that age（OR=1.041）,APACHE II score（OR=1.218） and initial TnⅠ level（OR=6.366） were the independent risk factors for ICU mortality,all P〈0.05.AUC of ROC for predictive value of ICU mortality in APACHE Ⅱ score was 0.763,in initial TnⅠ level was 0.778;their combination AUC was 0.803.Conclusion：Increased TnⅠ level at the early ICU admission was an independent risk factor for ICU mortality in non-cardiacsurgery critically ill patients which had predictive value for death.