年龄对脓毒症休克患者90天全因病死率影响的回顾性队列研究

The Effect of Age in Septic Shock Patients Associated with 90-day all-cause Mortality-A Retrospective Cohort Study

目的探讨年龄对脓毒症休克患者90d全因病死率的影响。方法回顾性分析2015年1月-2017年9月深圳市第二人民医院外科ICU收治的106例脓毒症休克患者的临床资料，以入科90d内结局分为存活及死亡组，比较患者一般资料，单因素及Cox回归分析探讨年龄对脓毒症休克90d全因病死率的影响，以受试者工作特征（receiveroperatingcharacteristic，ROC）曲线确定的最佳截点分为两组，Kaplan-Meier法比较两组90d全因病死率。结果外科重症监护室（intensivecareunit，ICU）脓毒症发病率26．2％，脓毒症休克发病率18．8％，90天全因病死率55．66％，两组在慢性阻塞性肺疾病（chronicobstructivepulmonarydisease，COPD）及ICU住院时间比较，差异有统计学意义（P〈0．05）。单因素分析显示两组在年龄、pH值、氧合指数、急性肾损伤、机械通气比例、APACHEII评分、SOFA评分比较，差异有统计学意义（P〈0．05）；Cox回归显示年龄是脓毒症休克患者90d全因病死率的危险因素（HR=1．016，P=0．048）。年龄与90d全因病死率的ROC曲线下面积为0．618（95％C10．511-0．724，P=0．038），年龄最佳截点75．5岁，敏感度42．4％，特异度83％。与年龄〈75．5岁患者相比，年龄≥75．5岁患者的90d全因病死率明显增加（P=0．003）。结论年龄是影响脓毒症休克患者90d全因病死率的独立危险因素，年龄每增加1岁，死亡风险增加1．6％，年龄最佳截点为75．5岁。

Objective To explore the effect of age on the 90-day all-cause mortality of septic shock patients. Methods The clinical data of 106 patients with septic shock were analyzed retrospectively. The outcome was divided into the survivals and non-survivals in 90 days. Basic characteristic were compared, univariate analysis and Cox regression analysis were used to explore the effect of age on 90-day all-cause mortality in septic shock patiens and the Receiver Operating Characteristic（ROC）eurve determined the best cut-off which was divided into two groups. The Kaplan-Meier method was used to compare 90-day all-cause mortality of the two groups . Results （1） The incidence of sepsis in surgical Intensive Care Unit（ICU） was 26.2%, the incidence of septic shock was 18.8%, and 90-day all-cause mortality in septic shock patients was 55.66%. The difference between the two groups in the Chronic Obstructive Pulmonary Disease（COPD）and the time of hospitalization of ICU was statistically significant （P 〈 0.05）. （2） Univariate analysis showed that the two groups were statistically significant in age, pH, oxygenation index, acute renal injury, mechanical ventilation ratio, APACHEII score and SOFA score （P 〈 0.05）, and Cox regression analysis showed that age was a risk factor on 90-day all-cause mortality in septic shock patients （HR=1.016, P =0.048）. （3）The area under the ROC curve of age and 90-day all-cause mortality was 0.618 （95% CI 0.511-0.724, P =0.038）, the best cut-off was 75.5 years,with sensitivity of 42.4%, specificity of 83% .（4）Aged /〉75.5 years of septic shock patients had a significantly higher 90-day all cause mortality rate compared with aged 〈75.5 years patients（P=0.003）.ConclusionsAge is an independent risk factor on 90-day all-cause mortality in septic shock patients, for every 1 year increased in age,the risk of death increases by 1.6% and the best cut-off was 75.5 years.