血清降钙素原与白蛋白比值联合序贯器官衰竭评估对脓毒症患者预后的预测价值

Prognostic value of serum procalcitonin/a lbumin ratio combined with sequential organ failure assessment in septic patients

目的探讨血清降钙素原与白蛋白比值(PCT/ALB)联合序贯器官衰竭评估(SOFA)对脓毒症患者预后的预测价值。方法回顾性分析2019年1月至2020年1月山西医科大学附属白求恩医院急诊科收治的75例脓毒症患者的临床资料,按照28 d预后将患者分为存活组(n=65)和死亡组(n=10)。监测患者入院当日的临床指标、并计算PCT/ALB以及SOFA。采用SPSS 26.0统计软件进行数据分析。采用t检验、χ^(2)检验比较组间差异,Cox回归分析脓毒症患者死亡的相关因素,绘制受试者工作特征(ROC)曲线分析相关因素对患者预后的预测价值。结果PCT、PCT/ALB、SOFA在死亡组中显著高于存活组,死亡组的ALB低于存活组,差异具有统计学意义(均P<0.05)。PCT/ALB(HR=4.527,95%CI 1.321~15.512)、SOFA(HR=1.287,95%CI 1.081~1.534)是脓毒症患者28 d死亡危险因素。PCT/ALB联合SOFA评分预测脓毒症患者预后的ROC曲线下面积为0.825,最佳截断点为1.824,灵敏度为80.0%,特异度为81.5%,优于单一指标的预测能力。结论PCT、ALB、PCT/ALB、SOFA可评估脓毒症患者病情严重程度,其中PCT/ALB、SOFA与脓毒症患者28 d死亡风险密切相关,PCT/ALB和SOFA联合预测脓毒症患者死亡风险价值优于单一指标的预测能力。

Objective To explore the prognostic value of serum procalcitonin/albumin ratio(PCT/ALB)combined with sequential organ failure assessment(SOFA)in septic patients.Methods A retrospective analysis was made of 75 patients with sepsis,who were treated in the Emergency Department of Bethun Hospital Affiliated to Shanxi Medical University from January 2019 to January 2020.The patients were divided into survival group(n=65)and death group(n=10)according to 28d outcomes.On admission,the patients were monitored for clinical indicators,PCT/ALB ratios and SOFA were calculated.SPSS statistics 26.0 was used for data analysis.t-test andχ^(2) were used for comparison.Cox regression was used to analyze the independent risk factors of sepsis,and receiver operating characteristic(ROC)curve was made to do the predictive analysis of risk factors in patients with sepsis.Results PCT,PCT/ALB,SOFA were higher in the survival group than in the death group,and ALB was lower in the death group than in the survival group,the difference being statistically significant(P<0.05 for both).PCT/ALB(HR=4.527,95%CI 1.321-15.512),SOFA(HR=1.287,95%CI 1.081-1.534)were independent risk factors for 28 d mortality risk.PCT/ALB combined SOFA was superior to other indicators in predicting patients with sepsis at 28 days,with an AUC of 0.825,the best cut-off point of 1.824,a sensitivity of 80.0%and a specificity of 81.5%.Conclusion PCT,ALB,PCT/ALB,SOFA are helpful for the assessment of septic patients condition.PCT/ALB and SOFA are independent risk factors for 28 d mortality.PCT/ALB combined with SOFA is superior to single indicator for prognosis of septic patients.