未成熟粒细胞结合SOFA评分对脓毒症患者预后的评估价值

Evaluation value of immature granulocytes combined with SOFA score on prognosis in patients with sepsis

目的评估未成熟粒细胞结合败血症相关器官功能障碍评分(SOFA)对脓毒症患者预后的价值。方法选取2016年10月～2017年12月在新疆维吾尔自治区人民医院ICU治疗且符合纳入排除标准的88例脓毒症患者。观察28 d后分为生存组和死亡组,比较两组急性生理学与慢性健康状况评分(APACHEⅡ)、SOFA评分及疾病严重程度相关临床指标,以及入院时的降钙素原(PCT)、C反应蛋白(CRP)、未成熟粒细胞绝对值(IG#)和未成熟粒细胞百分比(IG%)。运用ROC曲线比较IG#、IG%、SOFA评分以及联合检测对判断脓毒症预后的价值。结果最终生存组56例,死亡组32例。两组APACHEⅡ评分、SOFA评分、脓毒性休克、机械通气、机械通气时间、血管活性药物、连续肾替代治疗(CRRT)等指标比较,差异均有统计学意义(均P <0.05)。IG%及IG#均与SOFA评分呈正相关(r=0.630、0.574,均P <0.001)。ROC分析结果显示SOFA评分的曲线下面积(AUC)明显大于IG#和IG%。SOFA评分联合IG#及IG%的AUC明显大于其他单一指标。结论未成熟粒细胞是预测脓毒症患者预后的有用指标,与SOFA评分联合检测对不良预后的评估具有更高的敏感度和特异度。

Objective To evaluate the value of immature granulocytes combined with sepsis related organ failure assessment(SOFA)score in the prognosis of patients with sepsis.Methods From October 2016 to December 2017,88 patients with sepsis who were treated in People′s Hospital of Xinjiang Uygur Autonomous Region and met the inclusion and exclusion criteria were selected.After 28 days of observation,the patients were divided into survival group and death group.The acute physiology and chronic health evaluation(APACHEⅡ)score,SOFA score,clinical parameters related to disease severity,and procalcitonin(PCT),C-reactive protein(CRP),absolute value of immature granulocytes(IG#)and percentage of immature granulocytes(IG%)at admission were compared between the two groups.The ROC curve was used to compare IG#,IG%,SOFA score,and the value of combined detection in predicting the prognosis of sepsis.Results There were 56 cases in the final survival group and 32 cases in the death group.There were statistically significant differences between the two groups in APACHEⅡscore,SOFA score,septic shock,mechanical ventilation,mechanical ventilation time,vasoactive drugs and continuous renal replacement therapy(CRRT)(all P﹤0.05).IG%and IG#were positively correlated with SOFA scores(r=0.630,0.574,all P﹤0.001).ROC analysis showed that the area under the curve(AUC)of SOFA was significantly larger than IG#and IG%.The AUC of SOFA score combined with IG#and IG%was significantly larger than any other single indicator.Conclusion The immature granulocyte is a useful index to predict the prognosis of sepsis patients.Immature granulocytes combined with SOFA score detection has a higher sensitivity and specificity for the assessment of poor prognosis.