重症监护病房老年感染性休克患者的预后危险因素分析

Risk factors of prognosis in elderly patients with septic shock in ICU

目的分析重症监护病房(ICU)老年感染性休克患者预后危险因素,为临床判断和治疗提供参考。方法回顾性分析2015年11月至2019年3月宁波市医疗中心李惠利东部医院ICU收治的老年感染性休克患者,共113例,其中存活组73例,死亡组40例。分析两组患者的一般情况、基础疾病、实验室指标和侵入性操作,采用多因素Logistic回归分析感染性休克的预后危险因素,ROC曲线分析危险因素对死亡的预测价值。结果多因素Logistic回归分析显示,急性生理和慢性健康状况(APACHEII)评分(OR=1.344,95%CI 1.187~1.520,P<0.01)和入住ICU时乳酸水平(OR=1.311,95%CI 1.075~1.599,P<0.01)为预后的独立危险因素,血小板计数(OR=0.986,95%CI 0.976~0.996,P<0.01)和白蛋白水平(OR=0.812,95%CI 0.697~0.945,P<0.01)为预后的保护因素。ROC曲线分析显示:APACHEII评分、入住ICU时乳酸水平、APACHEII评分联合入住ICU时乳酸水平的曲线下面积分别为0.861(95%CI 0.784~0.919,P<0.01)、0.752(95%CI 0.662~0.828,P<0.01)、0.904(95%CI 0.834~0.951,P<0.01)。APACHEII评分联合入住ICU时乳酸水平的预测价值优于APACHEII评分、入住ICU时乳酸水平(Z=2.175和2.879,P<0.05和P<0.01)。结论降低APACHEII评分和乳酸水平、增加血小板计数、适当补充白蛋白有助于改善ICU老年感染性休克患者预后。APACHEII评分联合入住ICU时乳酸水平具有较好的死亡预测价值。

Objective To analyze the risk factors of prognosis in elderly patients with septic shock in ICU. Methods Clinical data of 113 elderly patients with septic shock admitted in the ICU of Ningbo Medical Center Lihuili Eastern Hospital from November 2015 to March 2019 were retrospectively analyzed. Among them, 40 patients died (death group) and 73 patients survived (survival group) within 28 d after diagnosis confirmed. The general information, underlying disease, laboratory findings and invasive operations were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors for prognosis of patients, and ROC curve was used to analyze the predictive value of risk factors for death. Results Multivariate Logistic regression analysis showed that APACHEII score(OR=1.344, 95%CI 1.187-1.520, P<0.01)and lactic acid level at admission(OR=1.311, 95%CI 1.075-1.599, P<0.01)were independent risk factors for prognosis, while platelet counts(OR=0.986, 95%CI 0.976-0.996, P<0.01)and albumin level(OR=0.812, 95%CI 0.697-0.945, P<0.01)were protective factors for prognosis. ROC curve analysis showed that the area under the curve of APACHEII score, lactic acid level at admission and APACHEII score combined with lactic acid level at admission were 0.861(95%CI 0.784-0.919, P<0.01), 0.752(95%CI 0.662-0.828, P<0.01)and 0.904(95%CI 0.834-0.951, P<0.01), respectively. The predictive value of APACHEII score combined with lactic acid level at admission was better than those of APACHEII score and lactic acid level at admission(Z=2.175 and 2.879, P<0.05 and P<0.01). Conclusions Lower APACHEII score and lactic acid level, increased platelet counts and albumin level may be associated with a favorable prognosis for elderly patients with septic shock. APACHEII score combined with lactic acid level at admission has better predictive value for prognosis.