新旧脓毒症诊断标准评估急诊感染患者危重程度的研究

Performance of new or old sepsis diagnostic criteria in the prognosis of patients with acute infection in Emergency Department

目的探讨新脓毒症诊断标准及旧脓毒症诊断标准对急诊感染患者危重程度分层的影响.方法选取2017年8月至2018年8月在北京朝阳医院急诊室就诊的急性感染患者192例.入选当日测定感染患者的基本生命体征、血乳酸(Lac)及急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ).应用两种不同筛选方案对所有急性感染患者进行分类,首先应用新脓毒症诊断标准将所有感染患者分为新脓毒症组(NS组)和新感染组(NI组),然后应用旧脓毒症诊断标准再次将所有感染患者分为旧脓毒症组(OS组)和旧感染组(OI组).比较NS组和NI组、OS组和OI组的血Lac、APACHE Ⅱ评分.比较NS组和OS组的血Lac阳性检出率及28 d病死率.应用ROC曲线评估血Lac、APACHE Ⅱ评分在NS组、NI组、OS组及OI组28 d病死率的预测价值.结果入选192例急性感染患者,应用新脓毒症诊断标准对所有感染患者进行分组,NS组83例(43.2%),NI组109例(56.8%),两组患者APACHE Ⅱ评分(分:11.63±4.5 vs.7.1±3.6,P<0.01)、血Lac(mmol/L:3.3-±2.6 vs.1.5-±0.8,P<0.01)差异有统计学意义.应用旧脓毒症诊断标准对所有感染患者进行分组,OS组163例(70.9%),OI组29例(15.1%),两组患者APACHE Ⅱ评分(分:9.6±4.6 vs.5.6±2.9,P<0.01)、血Lac(mmol/L:2.4±2.2 vs.1.5±1.3,P<0.05)差异有统计学意义.血Lac在NS组和OS组的阳性检出率差异有统计学意义(59.5%vs.38.7%,P<0.01).NS组和OS组28 d病死率差异有统计学意义(46.9%vs.25.8%,P<0.01).血Lac、APACHE Ⅱ评分在NS组预测28 d病死率的ROC曲线下面积是0.809、0.874,在OS组预测28 d病死率的ROC曲线下面积是0.827、0.875.结论与旧脓毒症诊断标准比较,应用新脓毒症诊断标准能更好地甄别危重的急性感染患者.

Objective To investigate the performance of new sepsis diagnostic criteria and old sepsis diagnostic criteria in the prognosis of patients with acute infection in Emergence Department(ED).Methods From August 2017 to August 2018,192 patients with acute infection were admitted to the Emergency Department of Beijing Chaoyang Hospital.The clinical characteristics,lactic acid(Lac)and APACHE H score were examined for each patient.Those patients were divided into new sepsis group(NS group)and new infection group(NI group)by new sepsis diagnosis criteria.Then those patients were divided into old sepsis group(OS group)and old infection group(01 group)by old sepsis diagnosis criteria again.Lac and APACHE Ⅱ score were compared between NS group and NI group,OS group and 01 group.The positive detection rate of Lac and 28-day mortality were calculated in NS group and OS group.The prediction accuracy of APACHE Ⅱ score and Lac in 28-day mortality was analyzed by ROC curve in NI group,NS group,OS group and 01 group.Results APACHE Ⅱ score and Lac were significantly higher in NS group than those in NI group(scores:11.63±4.5 vs.7.1±3.6,P<0.01;mmol/L:3.3±2.6 vs.1.5±0.8,P<0.01).APACHE Ⅱ score and Lac were significantly higher in OS group than in 01 group(scores:9.6±4.6 vs.5.6±2.9,P<0.01;mmol/L:2.4±2.2 vs.1.5±1.3,P<0.05).The positive detection rate of Lac had significant difference between NS group and OS group(59.5%vs.38.7%,P<0.01).Compared with OS group,significant difference was found in the 28-day mortality of the patients in NS group(46.9%vs.25.8%,P<0.01).The area under the ROC curve of Lac,APACHE Ⅱ score was 0.809,0.874 in NS group.The area under the ROC curve of Lac,APACHE U score was 0.827,0.875 in OS group.Conclusion Compared with old sepsis diagnosis criteria,patients with critical acute infection are easy to be identified by new sepsis diagnosis criteria.