老年脓毒症患者预后相关因素分析

Prognostic Factors of Sepsis in the Elderly

目的研究血清生化指标及免疫相关因子在老年脓毒症患者中的表达及对预后评估的价值。方法选取老年脓毒症患者405例,分为死亡组(n=132)与存活组(n=273),通过非参数检验比较2组临床资料的差异,以Logistic回归和ROC曲线分析老年脓毒症患者死亡的危险因素及检测指标对死亡的预测作用。结果脓毒症死亡组患者的血清C反应蛋白、NT-proBNP、D-二聚体、炎症因子IL-10含量、SOFA评分和APACHEⅡ评分均显著高于存活组(P<0.05),而炎症因子IL-8含量显著低于存活组(P<0.05);Logistic回归分析显示患者年龄、NT-proBNP、IL-8、IL-10和SOFA评分为老年脓毒症患者死亡的独立危险因素;ROC曲线显示NT-proBNP、IL-8、IL-10和SOFA评分均可以预测患者的死亡风险,联合4个变量进行预测时曲线下面积最高(0.798)。结论老年脓毒症患者的年龄、NT-proBNP、IL-8、IL-10含量和SOFA评分是患者死亡的独立危险因素。联合IL-8、IL-10、NT-proBNP和SOFA评分对老年脓毒症患者的预后可能具有更好的评估价值。

Objective To explore the expressions of serum biochemical index and immune-related factors in the elderly with sepsis and the value in prognostic evaluation.Methods 405 elderly with sepsis were selected and divided into 2 groups:death group(n=132) and survival group(n=273);nonparametric test was applied in the comparison of clinical data between the 2 groups while Logistic Regression analysis and ROC curve were applied in exploring the risk factors of death in the elderly with sepsis and the value of the detected index in predicting death.Results The expression levels of CRP,NT-proBNP,Ddimer,IL-10 and the scores of sepsis-related organ failure assessment(SOFA) and APACHE II were significantly higher(P<0.05) while the expression level of IL-8 was much lower(P<0.05) in death group than those in survival group;Logistic Regression analysis showed that age,expression levels of NT-proBNP,IL-8,IL-10 and SOFA score were the independent risk factors of death while the ROC curves indicated that expression levels of NT-proBNP,IL-8,IL-10 and SOFA score were of death prediction value in the elderly with sepsis,the prediction with the combination of the 4 variables led to the biggest area under curve(AUC)(0.798).Conclusions Age,expression levels of NT-proBNP,IL-8,IL-10 and SOFA score are the independent risk factors of death in the elderly with sepsis and the combination of the 4 variables(NT-proBNP,IL-8,IL-10 and SOFA score) is of better value in prognostic evaluation.