APRI联合血小板计数短期变化率对脓毒症相关肝损伤的预测价值

Predictive Value of Aspartate Transferase and Platelet Ratio Index Combined with Short-term Change Rate of Platelet Count in Sepsis Related Liver Injury

目的探讨天冬氨酸转移酶与血小板比值指数(aspartate transaminase to platelet ratio index,APRI)联合血小板计数短期变化率预测脓毒症相关肝损伤(sepsis-related liver injury,SRLI)发生的临床价值。方法回顾性选择2018年8月~2021年1月徐州医科大学附属医院重症医学科(intensive care unit,ICU)收治的脓毒症患者。收集患者的临床资料,根据入住ICU28天内是否发生肝损伤分为SRLI组和脓毒症非肝损伤组,比较两组患者各指标的差异。采用多因素Logistic回归分析筛选发生SRLI的危险因素;采用受试者工作特征(ROC)曲线评估APRI联合血小板计数短期变化率对SRLI发生的预测效能。结果共入组222例脓毒症患者,其中SRLI组102例,脓毒症非肝损伤组120例;SRLI组男性患者更多、体重指数更大,急性生理与慢性健康状况评分Ⅱ及序贯器官衰竭评分更高,ICU住院时长、机械通气时间更长,行气管切开术的患者更多,28天病死率更高;SRLI组患者在天冬氨酸氨基转移酶、谷氨酸氨基转移酶、谷氨酰转移酶、直接胆红素、总胆红素、乳酸水平上明显高于脓毒症非肝损伤组,SRLI组患者血小板计数较脓毒症非肝损伤组更低(P均<0.05),SRLI组患者的APRI及血小板计数短期变化率较脓毒症非肝损伤组患者更大(P<0.001);多因素Logistic回归分析显示,谷氨酸氨基转移酶、总胆红素、APRI、血小板计数短期变化率为预测SRLI发生的独立危险因素。ROC曲线结果显示,APRI预测SRLI发生的ROC曲线下面积(AUC)为0.841(95%CI:0.788~0.894),血小板计数短期变化率的AUC为0.787(95%CI:0.728~0.847);而APRI联合血小板计数短期变化率预测SRLI发生的AUC为0.905,当取最佳截断值0.44时,敏感度为82.4%,特异性为88.2%,优于单一指标对SRLI的诊断预测价值。结论APRI及血小板计数短期变化率可很好的预测SRLI的发生,当两者联合时,对SRLI发生的预测价值更高。

Objective To investigate the clinical value of aspartate transaminase to platelet ratio index(APRI)combined with short-term change rate of platelet count in predicting the occurrence of sepsis related liver injury(SRLI).Methods Sepsis patients admitted to the intensive care unit(ICU)of the affiliated hospital of Xuzhou medical university from August 2018 to January 2021 were retrospectively selected.Clinical data of patients were collected.Patients were divided into SRLI group and sepsis non-liver injury group according to whether liver injury occurred within 28 days after admission to ICU,and the differences of various indicators between the two groups were compared.Multivariate Logistic regression analysis was used to screen the risk factors of SRLI.Receiver Operating characteristic(ROC)curve was used to evaluate the predictive efficacy of APRI combined with the short-term change rate of platelet count on the occurrence of SRLI.Results A total of 222 sepsis patients were enrolled,including 102 patients in the SRLI group and 120 patients in the sepsis non-liver injury group.SRLI group had more male patients,higher body mass index,higher acute physiology and chronic health statusⅡand sequential organ failure score(SOFA),longer time staying in ICU and using invasive mechanical ventilation,more patients underwent tracheotomy,and higher 28-day mortality.The aspartate transaminase,alanine transaminase,glutamyl transferase,direct bilirubin,total bilirubin and lactic acid in the SRLI group were significantly higher than those in the non-liver injury group(P<0.05),and the APRI and short-term change rates of platelet count in the SRLI group were higher than those in the non-liver injury group(P<0.001)too.Multivariate Logistic regression analysis showed that alanine transaminase,total bilirubin,APRI and short-term change rate of platelet count were independent risk factors for predicting SRLI.ROC curve showed that the area under ROC curve(AUC)of APRI was 0.841(95%CI:0.788-0.894),and the AUC of short-term change rate of platelet count was 0.787(95%CI:0.728-0.847).The AUC of APRI combined with the short-term change rate of platelet count in predicting the occurrence of SRLI was 0.905.When the optimal truncation value was 0.44,the sensitivity and specificity were 82.4%and 88.2%,which were better than the prediction value of single index for SRLI.Conclusion APRI and the short-term change rate of platelet count can predict the occurrence of SRLI well.When the two indicators are combined,the prediction value is higher.