休克指数年龄休克指数对急性肺栓塞预后的评估价值

Shock index and age-based shock index in evaluating the prognosis of acute pulmonary embolism

目的 评估休克指数(shock index,SI)和年龄休克指数(age-based shock index,SIA)对急性肺栓塞患者的预后价值.方法 回顾性分析2014年1月至2018年12月在自贡市第四人民医院诊断为急性肺栓塞患者SI、SIA、肺栓塞严重指数(pulmonary embolism severity index,PESI),以发病6个月生存情况为终点指标,Kaplan-Meier生存分析法比较不同分组的SI、SIA生存曲线,单因素COX回归法确定SI、SIA是否为预测急性肺栓塞预后的独立危险因素,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),比较SI、SIA与PESI的预测价值.结果 急性肺栓塞患者283例,男性168例,女性115例,平均年龄(68.40±13.25)岁,存活234例(82.7%),死亡49例(17.3%).死亡组患者SI值[0.82(0.65,0.98)]及SIA值[55.82(45.61,70.97)]较存活组SI值[0.72(0.60,0.86)]及SIA值[49.22 (37.90,57.81)]更大.SI≤0.89组与SI >0.89组比较6个月生存率差异有统计学意义(P=0.000),SIA≤54.28组与SIA>54.28组比较6个月生存率差异有统计学意义(P =0.000).单因素COX回归分析,SI(β=0.992, SE=0.372, Wald=7.127,P=0.008)、SIA(β =0.014,SE =0.004,Wald =9.801 ,P =0.002)是预测6个月生存率的独立危险因素.SI预测6个月生存率曲线下面积(area under curve,AUC)0.615,SIA的AUC值0.658,PESI的AUC值为0.773,PESI的AUC值高于SI及SIA(P <0.05).结论 SI、SIA在急性肺栓塞的预后判断中均具有临床应用价值,但目前预测价值低于PESI.

Objective The purpose of this study was to evaluate the prognostic value of shock index(SI)and age-based shock index(SIA)in the patients with acute pulmonary embolism(PE).Methods The patients with acute pulmonary embolism diagnosed in Zigong Fourth People’s Hospital from January 2014 to December 2018 were analyzed retrospectively.SI,SIA and pulmonary embolism severity index(PESI)were calculated.The survival curves of SI and SIA in different groups were compared by Kaplan-Meier survival analysis.Univariate COX regression was used to determine whether SI and SIA were independent risk factors for predicting the prognosis of acute pulmonary embolism.The predictive value of SI,SIA and PESI was compared by drawing the receiver operating characteristic curve.Results From January 2014 to December 2018,283 patients with acute pulmonary embolism[man 168,female 115,mean age(68.40±13.25)years]234(82.7%)survived and 49(17.3%)died in Zigong Fourth People’s Hospital.The SI value[0.82(0.65,0.98)]and SIA value[55.82(45.61,70.97)]in the dead group were higher than those in the survival group[0.72(0.60,0.86)]and[49.22(37.90,57.81)].There was significant difference in 6-month survival rate between SI≤0.89 and SI>0.89(P=0.000).There was significant difference in 6-month survival rate between SIA≤54.28 and SIA>54.28(P=0.000).Univariate COX regression analysis showed that SI(β=0.992,SE=0.372,Wald=7.127,P=0.008)and SIA(β=0.014,SE=0.004,Wald=9.801,P=0.002)were independent risk factors for 6-month survival.The area under ROC of SI was 0.615,the area under ROC of SIA was 0.658,and the area under ROC of PESI was 0.773.The area under ROC of PESI was higher than that of SI and SIA(P<0.05).Conclusion Both SI and SIA have clinical value in predicting the prognosis of acute pulmonary embolism,yet their predictive value is lower than that of PESI.