影响脓毒症患者预后的危险因素分析

Risk factors influencing prognosis of patients with sepsis

目的探讨影响脓毒症患者预后的危险因素。方法将2017年6月至2019年6月本院急诊科收治的脓毒症患者106例纳入研究,根据患者出院后随访1个月的预后情况分为死亡组(28例)与存活组(78例)。对比两组血清降钙素原(PCT)、C反应蛋白(CRP)以及空腹血糖(FBG)水平,并分析影响患者预后的危险因素。结果第1天,存活组血清PCT水平为(4.22±1.25)ng/ml,低于死亡组(8.56±3.34)ng/ml,差异有统计学意义(P<0.05);第3天,存活组血清PCT、CRP水平分别为(1.88±0.75)ng/ml、(68.27±18.53)mg/L,均低于死亡组(15.83±6.21)ng/ml、(124.45±39.17)mg/L,差异均有统计学意义(均P<0.05);第5天,存活组血清PCT、CRP水平分别为(0.51±0.19)ng/ml、(59.43±13.74)mg/L,均低于死亡组(26.33±13.48)ng/ml、(153.26±42.28)mg/L,差异均有统计学意义(均P<0.05);存活组性别、原发病、高血压、冠心病、FBG水平与死亡组比较,差异均无统计学意义(均P>0.05);存活组年龄、SOFA评分、APACHEⅡ评分、血清PCT、CRP水平分别为(60.13±10.25)岁、(4.81±2.82)分、(17.85±2.33)分、(4.45±1.81)ng/ml、(68.25±15.62)mg/L,均低于死亡组(69.25±8.27)岁、(7.94±4.01)分、(60.57±10.65)分、(8.26±2.12)ng/ml、(158.68±45.53)mg/L,差异均有统计学意义(均P<0.05);经logistic回归分析,年龄、SOFA评分、APACHEⅡ评分、PCT、CRP是有效脓毒症预后的危险因素,差异有统计学意义(P<0.05)。结论血清PCT水平的升高可在一定程度上反映脓毒症患者病情的严重程度,并作为预测脓毒症患者预后的重要指标,同时结合血清CRP、SOFA评分、APACHEⅡ评分等可进一步提高脓毒症患者预后的预测效能。

Objective To explore the risk factors of prognosis in patients with sepsis.Methods 106 patients with sepsis admitted to our department from June,2017 to June,2019 were included in the study.According to their prognosis during the one-month follow-up after discharge,they were divided into a death group(28 cases)and a survival group(78 cases).The levels of serum procalcitonin(PCT),C-reactive protein(CRP),and fasting blood glucose(FBG)were compared between the two groups;and the risk factors affecting the prognosis were analyzed.Results On the first day,the serum level of PCT was lower in the survival group than in the death group[(4.22±1.25)ng/ml vs.(8.56±3.34)ng/ml],with a statistical difference(P<0.05).On the third and fifth day,the serum levels of PCT and CRP were lower in the survival group than in the death group[on the third day:(1.88±0.75)ng/ml vs.(15.83±6.21)ng/ml and(68.27±18.53)mg/L vs.(124.45±39.17)mg/L;on the fifth day:(0.51±0.19)ng/ml vs.(26.33±13.48)ng/ml and(59.43±13.74)mg/L vs.(153.26±42.28)mg/L],with statistical differences(both P<0.05).The were no statistical differences in gender,primary diseases,hypertension,coronary heart disease,and FBG level between the survival group and the death group(all P>0.05).The age,the scores of SOFA and APACHEⅡ,and the serum levels of PCT and CRP were lower in the survival group than in the death group[(60.13±10.25)years vs.(69.25±8.27)years,(4.81±2.82)vs.(7.94±4.01),(17.85±2.33)vs.(60.57±10.65),(4.45±1.81)ng/ml vs.(8.26±2.12)ng/ml,and(68.25±15.62)mg/L vs.(158.68±45.53)mg/L;all P<0.05].The logistic analysis showed that age SOFA score,APACHE score,PCT,and CRP were the risk factors of the prognosis of the patients(all P<0.05).Conclusion The increase of serum PCT level can reflect the severity of sepsis to a certain extent,so it can be used as an important indicator for predicting the prognosis of sepsis.At the same time,combined with serum CRP,SOFA score,APACHE II score,etc.,it can further improve the prediction of sepsis prognosis.