入院24h内APACHE Ⅱ评分及血乳酸值对ICU脓毒症患者预后的预测价值

Predictive value of APACHE Ⅱ score and blood lactate value within 24h after admission for the prognosis of sepsis patients in ICU

目的:探讨入院24 h内APACHE Ⅱ评分及血乳酸值对ICU脓毒症患者预后的预测价值。方法:选择2013年1月至2018年12月本院重症医学科收治的脓毒症患者295例,按照28 d预后情况分为存活组(174例)和死亡组(121例)。收集两组在入院24 h内的临床资料,分析脓毒症患者预后的独立危险因素,并分析APACHEⅡ评分及血乳酸值对脓毒症患者预后的预测能力。结果:多因素logistic回归分析显示,APACHE Ⅱ评分与血乳酸值升高是脓毒症患者死亡的独立危险因素(P<0.01);白蛋白是脓毒症患者死亡的保护性因素(P<0.01)。ROC曲线结果显示,APACHE Ⅱ评分、血乳酸值及其联合预测脓毒症患者预后的曲线下面积分别为0.717、0.663和0.734。结论:24 h内血乳酸值与APACHE Ⅱ评分对脓毒症患者预后有良好的预测能力,联合血乳酸值和APACHE Ⅱ评分能在一定程度上提高预测能力。

Objective:To investigate the predictive value of APACHE Ⅱ and blood lactate values within 24 h after admission for the prognosis of sepsis patients in ICU.Methods:A total of 295 sepsis patients admitted to the ICU of our hospital from January 2013 to December 2018 were selected and divided into survival group(n=174) and death group(n=121) according to the 28-day prognosis. The clinical data of the two groups within 24 h of admission were collected to analyze the independent risk factors for the prognosis of septic patients as well as the predictive ability of APACHE Ⅱ score and blood lactate value for the prognosis of septic patients.Results:Multivariate logistic regression showed that increased APACHE Ⅱ score and blood lactate value were independent risk factors for death in sepsis patients(P<0.01);albumin was a protective factor for death in sepsis patients(P<0.01). The results of the ROC curve showed that the area under the curve of APACHE Ⅱ score, blood lactate value and their combination in predicting the prognosis of sepsis patients were 0.717, 0.663 and 0.734, respectively.Conclusion:Blood lactate value and APACHE Ⅱ score within 24 h have a good predictive ability for the prognosis of sepsis patients, and the combination of lactate value and APACHE Ⅱ score can improve the predictive ability to a certain extent.