APACHEⅡ评分、PAR与老年脓毒症病情严重程度的关系及对短期预后的预测价值

Relationship between APACHEⅡScore and PAR with Severity of Sepsis in Elderly Patients and Its Value for Short-term Prognosis

目的探讨急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、降钙素原与白蛋白比值(PAR)与老年脓毒症患者病情严重程度的关系,并分析其对短期预后的预测价值。方法回顾性分析2016年5月—2020年9月诊治的328例老年脓毒症患者的临床资料,计算PAR、APACHEⅡ评分,比较不同病情脓毒症患者PAR、APACHEⅡ评分差异,多因素Cox回归分析患者28 d死亡的危险因素,受试者工作特征(ROC)曲线分析预测患者28 d死亡的临床价值。结果脓毒症休克患者入院时降钙素原(PCT)高于脓毒症、严重脓毒症患者,白蛋白(ALB)低于脓毒症、严重脓毒症患者(P<0.05)。脓毒症、严重脓毒症、脓毒症休克入院时APACHEⅡ评分、PAR逐渐升高(P<0.05)。328例脓毒症患者,28 d死亡73例,病死率为22.26%;脓毒症、严重脓毒症、脓毒症休克患者28 d病死率逐渐升高(P<0.05)。糖尿病、PAR>0.35、APACHEⅡ评分>22.75分、序贯器官衰竭评估(SOFA)评分>8.15分是老年脓毒症患者28 d死亡的独立危险因素(P<0.05,P<0.01)。APACHEⅡ联合PAR预测老年脓毒症28 d死亡的曲线下面积(AUC)为0.869,具有较高的预测价值。结论APACHEⅡ评分、PAR可反映老年脓毒症患者病情严重程度,二者联合检测预测老年脓毒症短期死亡的临床价值较优。

Objective To explore relationship between Acute Physiology and Chronic Health Status Score SystemⅡ(APACHEⅡ)score and procalcitonin/albumin ratio(PAR)with severity of sepsis in elderly patients,and to analyze its value for short-term prognosis.Methods Clinical data of 328 elderly patients with sepsis diagnosed during May 2016 and September 2020 was retrospectively analyzed.PAR and APACHEⅡscores were calculated,and differences of PAR and APACHEⅡscores were compared among sepsis patients with different conditions.Multivariate Cox regression was used to analyze risk factors for 28-d mortality.Receiver operating characteristic(ROC)curve analysis was used to predict clinical value of 28-d mortality.Results In patients with septic shock,procalcitonin(PCT)levels at the time of admission were higher,while albumin(ALB)levels were lower than those in patients with sepsis and severe sepsis(P<0.05).APACHEⅡscores and PAR values were gradually increased in patients with sepsis,severe sepsis and septic shock at the time of admission(P<0.05).Of 328 patients with sepsis,73 patients died within 28-d with a fatality rate of 22.26%,and the 28 d fatality rates were gradually increased in patients with sepsis,severe sepsis and septic shock(P<0.05).Diabetes,PAR more than 0.35,APACHEⅡscore more than 22.75 and sequential organ failure assessment(SOFA)score more than 8.15 were independent risk factors for 28-d mortality in elderly patients with sepsis(P<0.05,P<0.01).The AUC of APACHE combined with PAR in predicting 28-d mortality in elderly patients with sepsis was 0.869,which had a higher predictive value.Conclusion APACHEⅡscore and PAR may reflect severity of conditions,and combined detection of the two indexes has a better clinical value in predicting short-term death in elderly patients with sepsis.