血栓弹力图最大血块强度值联合动脉血乳酸检测对老年脓毒症患者预后的评估价值

Prognostic value of thromboelastography maximum amplitude and arterial blood lactate levels for sepsis in elderly patients

目的探讨血栓弹力图最大血块强度值(MA)联合动脉血乳酸检测对老年脓毒症患者病情程度及预后的评估价值。方法回顾性分析2018年12月至2020年2月山西白求恩医院重症医学科(ICU)收治的年龄≥60岁的脓毒症患者(63例)的病例资料,分析其入院时的血栓弹力图MA值、白细胞计数、淋巴细胞计数、血小板、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、基础疾病、体质指数、实验室检测指标及相关治疗。根据研究对象28 d生存结局分为生存组和死亡组,分析两组患者MA、APACHEⅡ评分、SOFA评分及上述实验室指标的差异,探讨MA与各感染指标及年龄的相关性,多因素Logistic回归分析生存结局的影响因素,受试者工作特征曲线(ROC)评价MA、乳酸对老年脓毒症患者预后的预测价值。结果63例老年脓毒症患者,主要感染来源为肺部及腹腔感染(79.4%、50/63),血培养阳性率为15.9%(10/63),病死率为66.7%(42/63)。生存组与死亡组的淋巴细胞计数、乳酸水平、MA值及ICU滞留时间的差异有统计学意义(t=3.847、2.153、2.745、-3.574,均P<0.05),且MA与乳酸、SOFA评分以及生存结局均具有相关性(r=-0.498、-0.506、-0.358,均P<0.05)。多因素Logistic回归分析结果显示,乳酸及MA值为影响脓毒症患者生存结局的独立影响因素(OR=1.626、0.766,均P<0.05)。乳酸、MA及二者联合预测老年脓毒症患者28 d死亡的曲线下面积及95%CI分别为0.77(0.521~0.832)、0.58(0.574~0.730)、0.89(0.763~0.846)(均P<0.05)。结论MA联合动脉血乳酸的检测对老年脓毒症患者的预后预测具有重要的临床价值。

Objective To evaluate the prognostic value of thromboelastography maximum amplitude(MA)and arterial blood lactate levels for sepsis in elderly patients.Methods Aretrospective analysis was performed on clinical data of 63 sepsis patients(≥60 years old)admitted tothe Intensive Care Unit(ICU)of Bethune Hospital of Shanxi Province from December 2018 to February2020.MA values,white blood cell counts,lymphocyte counts,platelets acute physiology and chronichealth evaluationⅡ(APACHEⅡ)scores,sequential organ failure assessment(SOFA)scores,underlying diseases,body mass index,laboratory test results and other related treatments wereanalyzed.The subjects were divided into the survival group and the death group according to the 28-daysurvival outcomc.Differences in MA,APACHEⅡscores,SOFA scorcs and laboratory tecst resultsbetween the two groups were analyzed,and the correlations of MA with infection parameters and agewere examined.Influencing factors of survival cutcomes were analyzed using multivariate Logisticregression.The receiver operating characteristic curve(ROC)was used to calculate the prognostic valueof MA and arterial lactate for sepsis in elderly patients.Results The main sources of infections were pulmonary and abdominal(79.4%,50/63)in 63 elderly patients with sepsis.The incidences of positive blood cultures and deaths were 15.9%(10/63)and 66.7%(42/63),respectively.There existedsignificant differences in lymphocyte counts,arterial lactate levels,MA and lengths of stay in the ICUbetween the survival group and the death group(t=3.847,2.153,2.745,-3.574,respectively,all P<0.05).MA was correlated with arterial lactate,SOFA score and survival outcome(r=-0.498,-0.506,and -0.358,respectively,all P≤0.05).Multivariate Logistic regression analysis showed thatMA and arterial lactate were independent factors for the survival outcome(OR=1.626,0.766,all P<0.05).The area under the ROC curve(AUC,95%CI)for the combination of MA and arterial lactatewas larger than that of either MA or arterial lactate alone(O.89,range:0.763-0.846;0.58,range:0.574-0.730;0.77,range:0.521-0.832;all P<0.05).Conclusions The combination ofthromboelastography maximum amplitude and lactate in arterial blood has important clinical value inassessing the prognosis of elderly patients with sepsis.