血浆可溶性尿激酶型纤溶酶原激活物受体在急诊严重创伤患者病情评估中的应用研究

Study on the application of plasma soluble urokinase type plasminogen activator receptor in the evaluation of emergency patients with severe trauma

目的:探讨血浆可溶性尿激酶型纤溶酶原激活物受体(suPAR)和损伤严重度评分(ISS)、新损伤严重度评分(NISS)、改良早期预警评分(MEWS)对急诊严重创伤患者病情危重程度的评估价值。方法:纳入2019年12月—2020年10月期间我院急救部抢救室接诊并收住院的严重创伤患者,入院后检测血浆suPAR并完善上述评分,根据入院24 h内的急性生理学和慢性健康状况评分(APACHE)Ⅱ及序贯器官衰竭评分(SOFA)将患者分为危重组和一般组,比较两组患者的一般情况、ISS、NISS、suPAR和MEWS,采用多因素Logistic回归分析患者病情危重的独立预测因子,绘制受试者工作特征(ROC)曲线明确各指标的评估价值。结果:共纳入101例严重创伤患者,其中危重组34例(33.7%),一般组67例(66.3%),危重组患者的血浆suPAR水平、ISS、NISS和MEWS均显著高于一般组[(6.9±2.7)ng/mL vs.(5.0±2.0)ng/mL,P=0.000;29(26,34)分vs.25(20,29)分,P=0.004;34(34,41)分vs.33(27,34)分,P=0.001;4(3,5)分vs.2(1,3)分,P=0.000],一般情况的组间差异无统计学意义(P>0.05);多因素Logistic回归分析显示入院时高MEWS、高血浆suPAR水平和高NISS是严重创伤患者病情危重的独立预测因子(OR=2.286,95%CI:1.501~3.482,P=0.000;OR=1.361,95%CI:1.062~1.744,P=0.015;OR=1.102,95%CI:1.014~1.198,P=0.022),ROC曲线下面积(AUC)分别为0.829(95%CI:0.741~0.896,P<0.001)、0.721(95%CI:0.623~0.806,P<0.001)、0.700(95%CI:0.601~0.788,P<0.001),取截断值>3分、>5.02 ng/mL、>33分时对应的敏感度和特异度分别为70.59%和83.58%、76.47%和61.19%、82.35%和53.73%;suPAR联合MEWS时AUC为0.857(95%CI:0.774~0.919,P<0.001),敏感度为73.53%,特异度为86.57%;suPAR联合NISS时AUC为0.819(95%CI:0.730~0.888,P<0.001),敏感度为91.18%,特异度为65.67%。结论:单独应用MEWS、血浆suPAR和NISS均能进一步评估严重创伤患者的病情危重程度,suPAR联合MEWS后评估效能最佳,更适用于急诊。

Objective:To explore the value of plasma soluble urokinase type plasminogen activator receptor(suPAR),injury severity score(ISS),new injury severity score(NISS),and modified early warning score(MEWS)in evaluating the critical degree of emergency patients with severe trauma.Methods:Patients with severe trauma who were hospitalized in the Emergency Department of Southwest Hospital of Army Medical University from December 2019 to October 2020 were included.Plasma suPAR was measured after admission and the above scores were calculated.The patients were divided into the critical group and the general group according to acute physiology and chronic health evaluation(APACHE)Ⅱand sequential organ failure assessment(SOFA).The general condition,ISS,NISS,suPAR,and MEWS of the two groups were compared.Multivariate Logistic regression was used to analyze the independent predictors of the critical condition after trauma,and the receiver operating characteristic(ROC)curve was drawn to investigate the value of each variable in evaluating the critical degree.Results:A total of 101 patients with severe trauma were included,with 34 cases in the critical group(33.7%)and 67 cases in the general group(66.3%).Plasma suPAR levels,ISS,NISS and MEWS in critical group were significantly higher than those in general group([6.9±2.7]ng/mL vs.[5.0±2.0]ng/mL,P=0.000;29[26,34]vs.25[20,29],P=0.004;34[34,41]vs.33[27,34],P=0.001;4[3,5]vs.2[1,3],P=0.000),and there was no significant difference in general condition between the two groups(P>0.05).Multivariate Logistic regression analysis showed that high MEWS,high plasma suPAR level and high NISS were independent predictors of critical condition in patients with severe trauma(OR=2.286,95%CI:1.501-3.482,P=0.000;OR=1.361,95%CI:1.062-1.744,P=0.015;OR=1.102,95%CI:1.014-1.198,P=0.022),and the area under the ROC curve(AUC)was 0.829(95%CI:0.741-0.896,P<0.001)、0.721(95%CI:0.623-0.806,P<0.001)and 0.700(95%CI:0.601-0.788,P<0.001),respectively.When the cutoff was>3,>5.02 ng/mL and>33,the sensitivity and specificity were 70.59%and 83.58%,76.47%and 61.19%,82.35%and 53.73%,respectively.The AUC of suPAR combined MEWS was 0.857(95%CI:0.774-0.919,P<0.001),the sensitivity was 73.53%,and the specificity was 86.57%.The AUC of suPAR combined NISS was 0.819(95%CI:0.730-0.888,P<0.001),the sensitivity was 91.18%,and the specificity was 65.67%.Conclusion:MEWS,plasma suPAR,and NISS alone can further evaluate the critical degree of emergency patients with severe trauma,and suPAR combined with MEWS has the best performance and is more suitable for emergency assessment.