血清丙酸对感染性休克早期诊断及预后的评估价值

Clinical Value of Serum Propionic Acid at Early Diagnosis and Mortality Predicts in Patients with Septic Shock

目的 探讨血清丙酸(PA)对感染性休克早期诊断及预后的评估价值。方法 将2015年3月~2017年12月医院收治的149例脓毒症患者分为非感染性休克组和感染性休克组,另选择同期在医院体检的50例健康人群为对照组。采用单因素分析各组临床资料的差异,Logistic回归分析感染性休克的独立危险因素,利用受试者工作曲线(ROC)曲线分析血清PA对感染性休克诊断及预后的价值,采用Kaplan-Meier法分析不同血清PA浓度的生存率。结果 非感染性和感染性休克组的呼吸频率、心率、PA、CRP、PCT、LA、WBC明显高于对照组,感染性休克组年龄、MAP、PA、CRP、PCT、LA、APACHEⅡ评分、SOFA评分、30 d死亡率、90 d死亡率明显高于非感染性休克组,差异有统计学意义(P<0.05)。多因素回归分析显示,年龄、PA、PCT、LA、APACHEⅡ得分是影响感染性休克的独立风险因素,低MAP和高血清PA浓度是感染性休克患者30 d和90 d死亡的独立危险因素(P均<0.05)。相关性分析显示,感染性休克患者血清PA浓度与PCT、LA、APACHEⅡ评分呈明显正相关(P<0.05)。ROC曲线显示,PA诊断感染性休克的AUC为0.912,最佳临界值为10.95 μg/L,敏感性为90.1%,特异性为77.6%。PA预测感染性休克30 d死亡的AUC为0.762,最佳临界值为12.52 μg/L,敏感性为75.9%,特异性为70.5%;PA预测感染性休克90 d死亡的AUC为0.766,敏感性为70.6%,特异性为74.1%。生存分析显示,PA低浓度组30 d生存率、90 d生存率均明显高于PA高浓度组,差异有统计学意义(P<0.05)。结论 感染性休克患者血清PA明显升高,可以作为疾病诊断和预后评估的指标。

Objective To assess the clinical value of serum propionic acid at diagnosis and mortality predicts in patients with septic shock.Methods From March 2015 to December 2017,a total of one hundred and forty-nine septic patients as well as fifty healthy volunteers were enrolled in this study.Septic patients were divided into septic shock group and non-septic shock group.Univariate analyses for the differece of clinical data,multivariate logistic regression analysis was employed to further identify the independent predictors of mortality and septic shock.Receiver operating characteristics (ROC) curves was used to evaluate prognostic and mortality of the biomarkers predicted sepsis shock.Survival rate of different PA concentration were performed by Kaplan-Meier method.Results Respiratory rate,heart rate,PA,CRP,PCT,LA,WBC were significantly higher in both septic shock group and non-septic shock group than control group.Meanwhile,MAP,PA,CRP,PCT,LA,APACHEⅡ score,SOFA score,30 d mortality and 90 d mortality were significantly higher in septic shock group than non-septic shock group,the differences between two groups were statistically significant (P<0.05).Multivariate logistic regression analysis showed that age,PA,PCT,APACHEⅡ score was independent factor of sepsis shock.Besides,low levels of MAP and high serum PA was independent factor of sepsis shock 30 d mortality and 90 d mortality (P<0.05).Correlation analysis showed that serum PA was positive correlation to PA,PCT and APACHEⅡ score (P<0.05).The ROC analysis showed the AUC of PA for predicting septic shock were 0.912,with cut-off 10.95 μg/L,with sensitivity and specificity was 90.1% and 77.6%,respectively.Using a PA cut-off of 12.52 μg/L for predicting septic shock 30 d mortality and 90 d–mortality,the sensitivity was 75.9% and 70.6%,the specificity was 70.5% and 74.1%,respectively.Log-rank survival analysis showed that 30 d survival and 90 d survival was significantly higher in low PA concentration group than high PA concentration group (P<0.05).Conclusion Propionic acid is markedly increased in septic shock patient,it can be used as a parameter for diagnostic and prognostic of septic shock.