脓毒性休克患者血清纤溶酶原激活物抑制剂-1与谵妄的相关性

Study on the correlation between the serum level of plasminogen activating inhibitor-1 and the delirium in the patients with septic shock

目的探讨脓毒性休克患者血清纤溶酶原激活物抑制剂-1(PAI-1)与谵妄的相关性。方法纳入脓毒性休克患者156例,依据患者入住重症监护病房(ICU)3 d内是否发生谵妄分为谵妄组(n=64)和非谵妄组(n=92),收集并比较两组患者的一般情况及实验室指标。采用Spearman相关分析探讨脓毒性休克患者血清PAI-1水平与白细胞介素-6(IL-6)及序贯器官衰竭评分(SOFA)的相关性;应用多因素Logistic回归模型分析脓毒性休克患者并发谵妄的相关影响因素;绘制受试者工作特征(ROC)曲线评估各指标对脓毒性休克患者并发谵妄的预测价值。结果本研究谵妄发生率为41.0%。谵妄组患者年龄、脑血管疾病比例、机械通气比例、SOFA评分、血清IL-6和PAI-1水平及28 d病死率高于非谵妄组,ICU停留时间延长,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,脓毒性休克患者血清PAI-1水平与血清IL-6水平及SOFA评分均呈显著正相关(r_(s)=0.297,P<0.001;r_(s)=0.252,P=0.001)。多因素Logistic回归分析结果显示,PAI-1水平升高(OR=1.011,95%CI 1.005~1.017,P<0.001)、IL-6水平升高(OR=1.005,95%CI 1.003~1.007,P=0.001)、高SOFA评分(OR=1.299,95%CI 1.095~1.542,P=0.003)、机械通气(OR=2.181,95%CI 1.011~3.351,P=0.037)及脑血管疾病(OR=1.703,95%CI 1.023~2.383,P=0.023)为脓毒性休克患者并发谵妄的独立危险因素。ROC曲线分析结果显示,血清PAI-1预测脓毒性休克患者并发谵妄的曲线下面积(AUC)明显大于IL-6及SOFA评分(0.831 vs.0.733,Z=1.987,P=0.047;0.831 vs.0.702,Z=2.547,P=0.011)。血清PAI-1截断值为264.5μg/L时,预测脓毒性休克患者并发谵妄的敏感度为81.3%,特异度为81.5%。结论血清PAI-1水平与脓毒性休克患者并发谵妄密切相关,对谵妄发生具有较高的预测价值。

Objective To explore the correlation between the serum level of plasminogen activating inhibitor-1(PAI-1)and the delirium in the patients with septic shock.Methods A total of 156 patients with septic shock were enrolled and were divided into the delirium group(n=64)and non-delirium group(n=92)according to whether there was the delirium within 3 days after the admission to Intensive Care Unit(ICU),and the baseline characteristics and the laboratory indicators were collected and compared between the two groups.The correlation of the serum PAI-1 level with the interleukin-6(IL-6)level and sequential organ failure assessment(SOFA)score in the patients with septic shock were explored by Spearman correlation analysis.The influence factors associated with concurrent delirium in the patients with septic shock were analyzed by multivariate Logistic regression model.And the predictive value of each marker for concurrent delirium in the patients with septic shock was evaluated by receiver operating characteristic(ROC)curve.Results The incidence of delirium in this study was 41.0%.The age,the proportion of cerebrovascular disease,the proportion of mechanical ventilation,the SOFA score,the serum IL-6 and PAI-1,and 28-day mortality in the delirium group were higher than those in non-delirium group,and the length of stay in ICU was longer,with statistically significant differences(P<0.05).Spearman correlation analysis showed that the serum PAI-1 level were positively correlated with both the serum IL-6 level(r_(s)=0.297,P<0.001)and the SOFA score(r_(s)=0.252,P=0.001).Multivariate Logistic regression analysis showed that the elevated PAI-1(OR=1.011,95%CI 1.005-1.017,P<0.001),the elevated IL-6(OR=1.005,95%CI 1.003-1.007,P=0.001),high SOFA score(OR=1.299,95%CI 1.095-1.542,P=0.003),mechanical ventilation(OR=2.181,95%CI 1.011-3.351,P=0.037)and cerebrovascular diseases(OR=1.703,95%CI 1.023-2.383,P=0.023)were independent risk factors for concurrent delirium in the patients with septic shock.ROC curve analysis showed that the area under ROC curve(AUC)of serum PAI-1 level was significantly larger than that of IL-6 and SOFA score(0.831 vs.0.733,Z=1.987,P=0.047;0.831 vs.0.702,Z=2.547,P=0.011).When the cut-off point of serum PAI-1 level was 264.5μg/L,the sensitivity and specificity to predict concurrent delirium were 81.3%and 81.5%,respectively.Conclusions The serum level of PAI-1 is closely related to the concurrent delirium in the patients with septic shock,and has a high predictive value for the concurrent delirium.