SOFA评分联合降钙素原在脓毒症中的应用价值

Application value of procalcitonin combined with SOFA score for sepsis patients

目的研究SOFA(sequential organ failure assessment)评分联合血清降钙素原(procalcitonin,PCT)对脓毒症患者病情和预后的评估意义。方法选择首都医科大学宣武医院2017年1月-2018年12月急诊科住院脓毒症患者135例,入院后给予血清PCT等化验检查,并进行SOFA评分和急性生理及慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ)。所有入组脓毒症患者随访28 d,根据患者临床转归分为生存组115例及死亡组20例,比较两组脓毒症患者血清PCT水平、白细胞计数(WBC)、SOFA评分和APACHEⅡ评分的差别,同时分析SOFA评分、血清PCT水平、APACHEⅡ评分、PCT和SOFA评分联合预测脓毒症患者死亡的受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积,并比较APACHEⅡ评分与其他研究指标的ROC曲线下面积(area under curve,AUC)的区别。结果脓毒症死亡组患者SOFA评分、APACHEⅡ评分和血清PCT水平均高于生存组(P<0.05),两组WBC比较无统计学差异(P=0.209);PCT预测患者死亡的AUC为0.646(P=0.027),SOFA评分的AUC为0.674(P=0.006),APACHE II评分AUC为0.830(P=0.001)。APACHE II评分AUC均大于PCT和SOFA评分(P=0.021,0.007),SOFA评分结合血清PCT的AUC为0.723(P=0.001),与APACHE II评分的AUC比较无统计学差异(P=0.107)。结论SO⁃FA评分结合血清PCT水平评价脓毒症患者疾病情况及转归的临床意义与APACHE II评分相近,均具有较好的临床应用价值。

Objective To evaluate prognostic value of serum procalcitonin(PCT)combined with sequential organ failure assessment score(SOFA)for sepsis patients.Methods 135 sepsis patients admitted to the Emergency Department were selected in XuanWu Hospital of Capital Medical University from January 2017 to December 2018,Serum PCT,SOFA score and acute physiology and chronic health evaluation(APACHE II)were performed after admission.After 28 days follow-up,according to patient clinical transition,the sepsis patients were divided into death group(20 cases)and survival group(115 cases).The differences of serum PCT level,WBC,SOFA score and APACHE II score were compared between the two groups.At the same time,the receiver operating characteristic curve(ROC)for predicting the death of sepsis patients of SOFA score,serum PCT level,APACHE II score and PCT combined with SOFA score were analyzed.The differences between the area under the curve(AUC)of APACHE II score and other research indicators were compared.Results The SOFA score,APACHE II score and serum PCT level of death patients were higher than those in survival patients(P<0.05).WBC was no obvious difference between the two groups(P=0.209).The AUC of the PCT predicted death was 0.646(P=0.027),the AUC of the SOFA score was 0.674(P=0.006),and the AUC of the APACHE II score was 0.830(P=0.001).The AUC of APACHE II score was higher than that of PCT and SOFA score(P=0.021,0.007).The AUC of PCT combined with SOFA score was 0.723(P=0.001).There was no obvious difference between the AUC of APACHE II score and the AUC of PCT combined with SOFA score(P=0.107).Conclusion The clinical value of serum PCT combined with SOFA score in predicting the clinical transition of sepsis patients is similar to APACHE II score,which has a good predictive value in evaluating the clinical transition of sepsis patients.