Pcv-aCO_(2)/Ca-cvO_(2)联合ROX指数对脓毒症患者病情及预后的价值

Value of Pcv-aCO_(2)/Ca-cvO_(2)combined with ROX index in evaluating severity and prognosis of patients with sepsis

目的探究中心静脉-动脉血二氧化碳分压差与动脉-中心静脉氧含量差比值(Pcv-aCO_(2)/Ca-cvO_(2))联合ROX指数对评估脓毒症患者病情及预后的价值。方法选择2021年1月至2022年2月合肥市第一人民医院南区收治的76例脓毒症患者。根据患者是否出现多器官功能障碍综合征(MODS)分为重症组(n=30),未出现MODS为轻症组(n=46),并调查患者诊断脓毒症并治疗后28 d是否存活分为死亡组(n=18)和存活组(n=58),分别比较重症组和轻症组患者,死亡组和存活组患者在确诊脓毒症后1 h内的一般资料数据、Pcv-aCO_(2)/Ca-cvO_(2)、ROX指数差异;采用受试者工作特征(ROC)曲线分析Pcv-aCO_(2)/Ca-cvO_(2)联合ROX指数对脓毒症患者病情严重程度及预后的诊断价值。结果(1)重症组患者Pcv-aCO_(2)/Ca-cvO_(2)高于轻症组,ROX指数低于轻症组,差异有统计学意义(P<0.05);ROX指数、Pcv-aCO_(2)/Ca-cvO_(2)和2者联合评估脓毒症患者病情严重程度的曲线下面积(AUC)分别为0.768、0.834和0.878,灵敏度分别为80.00%、83.30%和90.0%,特异度分别为65.20%、76.10%和67.40%,约登指数分别为0.452、0.594和0.574;ROX和Pcv-aCO_(2)/Ca-cvO_(2)预测脓毒症病情严重程度的截断值分别为7.05和1.53;(2)死亡组患者Pcv-aCO_(2)/Ca-cvO_(2)高于存活组,ROX指数低于存活组,差异有统计学意义(P<0.05);ROX指数、Pcv-aCO_(2)/Ca-cvO_(2)和2者联合预测脓毒症患者预后的AUC分别为0.796、0.851和0.894,灵敏度分别为77.80%、55.6%和83.30%,特异度分别为69.00%、98.30%和91.40%,约登指数分别为0.468、0.594和0.747;ROX和Pcv-aCO_(2)/Ca-cvO_(2)预测脓毒症预后的截断值分别为6.46和2.01。结论联合检测指标ROX+Pcv-aCO_(2)/Ca-cvO_(2)可提高评估脓毒症患者病情及预后的准确性。

Objective To explore the value of central venous-arterial blood carbon dioxide differential pressure and arterial-central venous oxygen content difference ratio(Pcv-aCO_(2)/Ca-cvO_(2))combined with ROX index in evaluating the severity and prognosis of patients with sepsis.Methods From Jan 2021 to Feb 2022,76 patients with sepsis in theSouth District of Hefei First People’s Hospital were selectedand divided into severe group(n=30)according to whether they had multiple organ dysfunction syndrome(MODS)and mild group(n=46)according to whether they had no MODS.The patients were divided into death group(n=18)and survival group(n=58)according to whether they were diagnosed with sepsis and survived 28 days after treatment.The general data,Pcv-aCO_(2)/Ca-cvO_(2)and ROX indexes of the patients in the severe group and mild group were compared respectively.The diagnostic value of Pcv-aCO_(2)/Ca-cvO_(2)combined with ROX index in the severity and prognosis of sepsis patients was analyzed by receiver operating characteristic(ROC)curve.Results(1)The Pcv-aCO_(2)/Ca-cvO_(2)in the severe group was higher than that in the mild group,and the ROX index was lower than that in the mild group(P<0.05).The area under the curve(AUC)of ROX index,Pcv-aCO_(2)/Ca-cvO_(2)and ROX+Pcv-aCO_(2)/Ca-cvO_(2)to assess the severity of sepsis was 0.768,0.834 and 0.878,respectively,the sensitivity was 80.00%,83.30%and 90.0%,respectively,the specificity was 65.20%,76.10%and 67.40%,respectively,and the Youden index was 0.452,0.594 and 0.574,respectively.The cut-off value of ROX and Pcv-aCO_(2)/Ca-cvO_(2)for predicting the severity of sepsis was 7.05 and 1.53,respectively.(2)The Pcv-aCO_(2)/Ca-cvO_(2)in the death group was higher than that in the survival group,and the ROX index was lower than that in the survival group(P<0.05).The area under the curve(AUC)of ROX index,Pcv-aCO_(2)/Ca-cvO_(2)and ROX+Pcv-aCO_(2)/Ca-cvO_(2)in predicting the prognosis of sepsis patients was 0.796,0.851 and 0.894,respectively,the sensitivity was 77.80%,55.6%and 83.30%,respectively,the specificity was 69.00%,98.30%and 91.40%,respectively,and the Youden index was 0.468,0.594 and 0.747 respectively.The cut-off value of ROX and Pcv-aCO_(2)/Ca-cvO_(2)in predicting the prognosis of sepsis was6.46 and 2.01,respectively.Conclusions The combined detection index ROX+Pcv-aCO_(2)/Ca-cvO_(2)can improve the accuracy of evaluation for the severity and prognosis of patients with sepsis.