D-二聚体联合血清白蛋白对急诊科老年脓毒症患者预后的评估

Prognosis assessment of elderly patients with sepsis in emergency department based on D-dimer and serum albumin

目的观察老年脓毒症患者D-二聚体(D-dimer)、血清白蛋白(ALB)的变化,评估两者对老年脓毒症患者预后的临床预测价值。方法采用回顾性研究,收集2019年1月至2020年11月上海交通大学医学院附属第九人民医院急诊科收治的老年脓毒症(根据脓毒症-3标准定义)患者103例,根据出院时的预后分为存活组(78例)和死亡组(25例),使用独立样本t检验比较两组患者入院24 h内血白细胞(WBC)、血小板(PLT)、C反应蛋白(CRP)、D-dimer和ALB的水平。通过logistic回归分析影响患者预后的独立危险因素。应用ROC曲线和曲线下面积(AUC)评价D-dimer、ALB、及以D-dimer和ALB联合预测因子(D-dimer/ALB)对老年脓毒症患者预后的评估价值。结果死亡组D-dimer水平[(9.39±7.74)mg/L比(2.08±1.71)mg/L]显著高于存活组(P<0.01),死亡组ALB水平[(29.84±4.24)g/L比(32.54±4.89)g/L]显著低于存活组(P=0.011)。多因素logistic回归分析显示,D-dimer(OR=1.589,P<0.01)、ALB(OR=0.816,P<0.05)与脓毒症患者死亡发生风险增加相关。ROC曲线分析显示,D-dimer水平对脓毒症老年患者的院内死亡率具有出色的预测能力(AUC=0.863,P<0.001)。单独检测D-dimer与ALB判断老年脓毒症患者预后的AUC差异有统计学意义(0.863比0.669,P=0.0095),而联合指标D-dimer/ALB与D-dimer单独检测的AUC比较,差异无统计学意义(0.874比0.863,P=0.1110)。D-dimer的最佳截断点为2.70 mg/L,此时预测老年脓毒症患者的敏感度为92.00%,特异度为70.50%,对预测预后具有较好的准确度。结论D-dimer、ALB以及D-dimer/ALB与老年脓毒症患者的预后密切相关,其中D-dimer预测老年脓毒症患者预后的价值较高。

Objective To observe the changes of D-dimer and serum albumin(Albumin,ALB)in elderly patients with sepsis,and to evaluate their clinical predictive value for prognosis of sepsis in the elderly.Methods Using a retrospective study design,53 elderly patients with diagnosed sepsis under the sepsis-3 criteria admitted to emergency department of Shanghai 9th People′s Hospital Affiliated to Shanghai Jiaotong University Medical School from January 2019 to November 2020 were recruited.Patients were divided into survival group(78 cases)and non-survival group(25 cases)according to their prognosis at discharge.Levels of white blood cell(WBC),platelet(PLT),C-reactive protein(CRP),D-dimer,and ALB within 24 hours of admission between two groups were compared using independent t-test.Multivariate logistic regression was performed to identify independent risk factors related to prognosis.The Receiver Operating Characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value of D-dimer,ALB and joint factor D-dimer/ALB on the prognosis of elderly sepsis patients.Results Independent t-test indicated that the non-survival group had significant higher levels of D-dimer[(9.39±7.74)mg/L vs.(2.08±1.71)mg/L,P<0.01]and lower levels of ALB versus the survival group[(29.84±4.42)g/L vs.(32.54±4.89)g/L,P=0.011].Logistic regression analysis revealed D-dimer(OR=1.589,P<0.01),ALB(OR=0.816,P<0.05),were associated with an increased risk of death in patients with sepsis.ROC curve analysis showed D-dimer level has excellent predicting ability in within-hospital mortality of senile patients with sepsis(AUC=0.863,P<0.001).The AUC value of D-dimer was significantly larger than that of ALB(0.863 vs.0.669,P=0.0095).And the AUC value of D-dimer/ALB(AUC=0.874)has no significant difference with that of D-dimer(P=0.1110).The best prognostic cutoff point for D-dimer was 2.70 mg/L,at which level the sensitivity and specificity were 92.00%and 70.50%,respectively.Conclusions Blood plasma D-dimer,ALB and D-dimer/ALB is strongly associated with the prognosis of elderly patients with sepsis.Among them,D-dimer has a higher predictive value of prognosis of elderly sepsis patients.