脓毒症患者血清总胆红素水平的动态变化及临床价值分析

Dynamic changes and clinical value of serum tbil levels in patients with sepsis

目的探讨脓毒症患者血清总胆红素(TBIL)的动态变化及其与病情程度的相关性和预后预测价值。方法选取2015年9月至2019年8月入住浙江医院治疗的脓毒症患者,根据入院28 d时存活情况分为存活组和死亡组。检测患者入院后1 d、3 d、7 d检测血清TBIL、C反应蛋白(CRP)、降钙素原(PCT)、乳酸(LAC)水平,并记录急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)、器官功能序贯衰竭评分(SOFA)、多器官功能障碍评分(MODS)。绘制受试者特征曲线(ROC),比较各指标对临床预后的预测价值,并进行血清TBIL与其它观察指标之间的相关性分析。结果存活组患者的入院后1 d、3 d、7 d的TBIL、CRP、PCT、LAC水平、APACHEⅡ、SOFA、MODS评分呈现为持续下降(F=68.315、38.273、59.238、30.147、22.581、36.549、43.182,P<0.05),且均小于同期死亡组患者(P<0.05)。ROC曲线显示,TBIL的曲线下面积(AUC)为0.807(95%CI:0.668~0.951,P<0.01),明显高于其他观察指标。入院后3 d血清TBIL与LAC和临床评分均呈显著正相关关系(r=0.670、0.781、0.661、0.732,P<0.05)。结论脓毒症患者血清TBIL水平在疾病早期明显升高,随后呈下降趋势,与病情严重程度呈正相关,并可作为预测脓毒症患者临床预后的观察指标。

Objective To analyze the dynamic changes of serum total bilirubin(TBIL)in patients with sepsis,and its correlation with severity of the disease and its predictive value of prognosis.Methods Patients with sepsis hospitalized in Zhejiang Hospitial from September 2015 to August 2019 were divided into survival group and death group according to their survival at 28 days after admission.Serum TBIL,C-reactive protein(CRP),procalcitonin(PCT),lactic acid(LAC)were measured on the 1 st,3 rd and 7 th day after admission,and acute physiology and chronic health score systemⅡ(APACHEⅡ),organ function sequential failure score(SOFA)and multiple organ dysfunction score(MODS)were recorded.The characteristic curve(ROC)of subjects were draw to compare the predictive value of each index to clinical prognosis,and the correlation between serum TBIL and other observation indexes were analyzed.Results The levels of TBIL,CRP,PCT,LAC and scores of APACHEⅡ,SOFA and MODS at 1 d,3 d and 7 d after admission in the survival group showed a continuous decline(F=68.315,38.273,59.238,30.147,22.581,36.549,43.182;P<0.05),and were lower than those in the death group at the same time(P<0.05).ROC curve showed that AUC of TBIL was 0.807(95%CI:0.668-0.951,P<0.01),which was significantly higher than other indexes.Serum TBIL were positively correlated with LAC and clinical scores at 3 d after admission(r=0.670,0.781,0.661,0.732;P<0.05).Conclusion The serum TBIL levels of sepsis patients increased significantly in the early stage,and then decreased,which was positively correlated with the severity of the disease,and could be used as an effective index to predict the clinical prognosis of patients with sepsis.