血小板-淋巴细胞比值联合序贯器官衰竭评分对院内心脏骤停患者短期预后的评估价值研究

Study on the value of platelet-lymphocyte ratio combined with Sequential Organ Failure Assessment score for evaluating short-term prognosis of in-hospital cardiac arrest patients

目的研究恢复自主循环(return of spontaneous circulation,ROSC)后首次血小板-淋巴细胞比值(platelet-lymphocyte ratio,PLR)联合序贯器官衰竭评分(Sequential Organ Failure Assessment,SOFA)对院内心脏骤停(in-hospital cardiac arrest,IHCA)患者ROSC后短期预后的评估价值。方法回顾性纳入2010年8月1日00:00-2018年7月31日23:59于四川大学华西医院急诊科治疗期间发生IHCA并经过抢救后成功ROSC的成年患者。收集患者的基本资料和临床资料。根据28 d预后将患者分为存活组与死亡组。通过logistic回归及受试者工作特征(receiver operating characteristic,ROC)曲线分析探究ROSC后首次PLR联合SOFA评分对IHCA患者28 d预后的预测效能。结果共纳入199例患者,其中男135例,女64例;平均年龄(60.45±17.52)岁;28 d内死亡154例,存活45例。存活组与死亡组比较,肾上腺素用量、SOFA评分、合并呼吸系统疾病比例以及ROSC后首次PLR、血红蛋白、红细胞计数、淋巴细胞计数、间接胆红素、血清白蛋白、胆固醇、活化部分凝血活酶时间组间差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,肾上腺素用量[比值比(odds ratio,OR)=1.177,95%置信区间(confidence interval,CI)(1.024,1.352),P=0.022]、SOFA评分[OR=1.536,95%CI(1.173,2.010),P=0.002]、ROSC后首次PLR[OR=1.011,95%CI(1.004,1.018),P=0.002]是ROSC患者28 d死亡的独立危险因素。肾上腺素用量、SOFA评分、ROSC后首次PLR对患者28 d结局预测效能均不高,曲线下面积分别为0.702、0.703和0.737。将肾上腺素用量、ROSC后首次PLR分别联合SOFA评分用于患者28 d结局预测,曲线下面积分别为0.768和0.813。结论ROSC后首次PLR水平显著升高是ROSC后患者28 d死亡的独立危险因素。将ROSC后首次PLR与SOFA评分联合用于患者28 d结局预测具有较好的预测效能。

Objective To explore the value of platelet-lymphocyte ratio(PLR)after return of spontaneous circulation(ROSC)combined with Sequential Organ Failure Assessment(SOFA)for estimating the short-term prognosis of ROSC patients suffered from in-hospital cardiac arrest(IHCA).Methods ROSC adult patients who suffered from IHCA during treatment in the Emergency Department of West China Hospital of Sichuan University between 00:00,August1 st,2010 and 23:59,July 31 st,2018 were included retrospectively.The basic and clinical data of patients were collected.Patients were divided into survival group and death group according to the 28-day prognosis.Through logistic regression and receiver operating characteristic(ROC)curve analysis,the efficacy of PLR after ROSC combined with SOFA score in predicting the 28-day prognosis of IHCA patients was explored.Results A total of 199 patients were included,including135 males and 64 females,with a mean age of(60.45±17.52)years old.There were 154 deaths and 45 survivors within 28 days.There were statistically significant differences between the survival group and the death group in terms of epinephrine dosage,SOFA score,proportion of patients complicated with respiratory diseases,and post-ROSC laboratory indexes including PLR,hemoglobin,red blood cell count,lymphocyte count,indirect bilirubin,serum albumin,cholesterol,and activated partial thrombin time(P<0.05).The result of multivariate logistic regression analysis showed that epinephrine dosage[odds ratio(OR)=1.177,95%confidence interval(CI)(1.024,1.352),P=0.022],SOFA score[OR=1.536,95%CI(1.173,2.010),P=0.002],PLR after ROSC[OR=1.011,95%CI(1.004,1.018),P=0.002]were independent risk factors for ROSC patients’death on day 28.The areas under the ROC curve of epinephrine dosage,SOFA score and PLR after ROSC were 0.702,0.703 and 0.737,respectively,to predict the patients’28-day outcome.Combining the epinephrine dosage and PLR after ROSC with SOFA score respectively to predict the 28-day outcome of patients,the areas under the ROC curve were 0.768 and 0.813,respectively.Conclusions The significant increase of PLR after ROSC is an independent risk factor for death within 28 days after ROSC.The combined application of PLR after ROSC and SOFA score in the 28-day outcome prediction of patients has better predictive efficacy.