初次入住ICU外科疾病患者病死率与输血的相关性分析

Analysis on correlation between mortality of surgical disease patients initially admitted into intensive care unit and blood transfusion

目的分析初次入住重症监护病房(ICU)外科疾病患者病死率与输血的相关性。方法采用回顾性研究方法。选择2019年5月至2020年4月在达州市中西医结合医院接受治疗的初次入住ICU外科疾病患者作为研究对象。将患者按90 d预后分为生存组和死亡组。收集患者的一般资料、实验室指标及输血情况等指标,比较不同预后两组患者上述指标的差异。采用多因素Logistic回归分析影响初次入住ICU外科疾病患者预后的影响因素;并绘制受试者工作特征曲线(ROC曲线)评价各危险因素对患者预后的预测价值;采用Spearman相关性分析法分析输血次数、输血种类与患者预后的相关性。结果共纳入192例患者,107例(55.73%)患者在初次入住ICU后90 d内死亡。与生存组比较,死亡组急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)均明显升高〔APACHEⅡ评分(分):16.02±4.28比10.84±2.01,SOFA评分(分):8.25±1.03比4.16±1.05〕,格拉斯哥昏迷评分(GCS)、收缩压、血小板分布宽度(PDW)、输血比例均明显降低〔GCS(分):8.03±2.88比11.05±3.21,收缩压(mmHg,1 mmHg≈0.133 kPa):81.05±9.11比95.62±8.11,PDW:(9.57±2.21)%比(13.03±2.33)%,输血比例:22.43%(24/107)比43.53%(37/85),均P<0.05〕,凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)均明显增加〔PT(s):21.18±3.94比15.07±4.06,INR:1.81±0.39比1.25±0.32,APTT(s):45.03±14.17比39.61±12.73,均P<0.05〕。多因素Logistic回归分析显示,SOFA评分≥6分、输血是影响初次入住ICU外科疾病患者死亡的独立性危险因素〔优势比(OR)和95%可信区间(95%CI)分别为1.713(1.308~2.249)、0.122(0.044~0.340),均P<0.05〕。ROC分析显示,SOFA评分≥6分、输血对初次入住ICU外科疾病患者预测均有一定的预测价值〔ROC曲线下面积(AUC)分别为0.707和0.893,95%CI分别为0.595~0.819和0.823~0.962,均P<0.01〕。相关性分析显示,输血次数、输血种类均与患者预后呈正相关(r值分别为0.621和0.703,P值分别为0.003和0.019)。随着输血次数及输血种类的增加,患者的病死率均明显升高,输血2次以下、2~5次、5次以上患者的病死率分别为21.5%(23/107)、35.5%(38/107)、43.0%(46/107),P<0.05;输注1、2、3种成分血患者的病死率分别为29.0%(31/107)、34.6%(37/107)、36.4%(39/107),P<0.05。结论初次入住ICU的外科疾病患者预后与SOFA评分及输血呈正相关;随着输血次数及种类的增加患者病死率升高。

Objective To analyze the correlation between the mortality and blood transfusion of surgical patients admitted to the intensive care unit(ICU)for the first time.Methods A retrospective research was conducted.The patients with surgical diseases who were admitted to the ICU for the first time and received treatment in Dazhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to April 2020 were selected as the research subjects.The patients were divided into a survival group and a death group according to 90-day prognosis.The general data,laboratory indexes and blood transfusion conditions of the patients were collected,and the differences in the above indexes between the two groups of patients with different prognoses were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors for the prognosis of patients with surgical diseases who were admitted to the ICU for the first time,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor on the prognosis of patients.Spearman correlation coefficient was used to analyze the correlation between the number of blood transfusions,the types of blood transfusion components and the prognosis of patients.Results A total of 192 patients were included,and 107(55.73%)patients died within 90 days after their initial ICU admission.Compared with the survival group,the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and the sequential organ failure assessment(SOFA)in the death group were significantly higher(APACHEⅡscore:16.02±4.28 vs.10.84±2.01,SOFA score:8.25±1.03 vs.4.16±1.05),Glasgow coma scale(GCS),systolic blood pressure,platelet volume distribution width(PDW)and blood transfusion ratio were significantly decreased[GCS score:8.03±2.88 vs.11.05±3.21,systolic blood pressure(mmHg,1 mmHg≈0.133 kPa):81.05±9.11 vs.95.62±8.11,PDW:(9.57±2.21)%vs.(13.03±2.33)%,blood transfusion ratio:22.43%(24/107)vs.43.53%(37/85),all P<0.05],prothrombin time(PT),international normalized ratio(INR)and activated partial thromboplastin time(APTT)were significantly increased[PT(s):21.18±3.94 vs.15.07±4.06,INR:1.81±0.39 vs.1.25±0.32,APTT(s):45.03±14.17 vs.39.61±12.73,all P<0.05].Multivariate Logistic regression analysis showed that SOFA≥6 points and blood transfusion were independent risk factors for death in patients with surgical diseases initially admitted to the ICU[odds ratio(OR)and 95%confidence interval(95%CI)were 1.713(1.308-2.249),0.122(0.044-0.340),both P<0.05].The results of ROC analysis showed that SOFA≥6 points and blood transfusion had certain predictive value in predicting surgical diseases in patients initially admitted to the ICU[area under ROC curve(AUC)were 0.707 and 0.893,respectively,95%CI were 0.595-0.819 and 0.823-0.962,both P<0.01].Correlation analysis showed that the number of blood transfusions and types of blood transfusions were positively correlated with the prognosis of patients(r values were 0.621 and 0.703,P values were 0.003 and 0.019,respectively).The mortality of patients was increased significantly with the increase in the number of blood transfusion and types of blood transfusion;the mortality of patients with less than 2 times of blood transfusion,2-5 times,and more than 5 times were 21.5%(23/107),35.5%(38/107),and 43.0%(46/107),respectively,P<0.05;the mortality of patients receiving 1,2,and 3 blood components were 29.0%(31/107),34.6%(37/107),and 36.4%(39/107),respectively,P<0.05.Conclusions The prognosis of patients with surgical disease staying in ICU the first time is positively correlated with SOFA score and blood transfusion.The mortality of the patients is elevated with the increase of number of blood transfusion and type of blood transfusion.