血管活性药物评分、休克评分和乳酸水平对脓毒性休克足月儿结局的预测价值

Comparison of the predictive value of vasoactive-inotropic score,shock score and lactate level for the outcome of septic shock in term infants

目的探讨血管活性药物评分(vasoactive-inotropic score, VIS)、休克评分和乳酸水平对脓毒性休克足月儿结局的预测价值。方法选择2019年1月至2020年10月广东省妇幼保健院新生儿科住院并诊断为脓毒性休克的足月儿进行回顾性研究, 根据结局分为存活组和死亡组, 比较两组患儿相关因素的差异, 通过多因素Logistic回归分析脓毒性休克足月儿死亡的独立危险因素, 并利用受试者工作特征曲线比较VIS、休克评分及乳酸水平对脓毒性休克足月儿结局的预测效能。结果共纳入82例脓毒性休克足月儿, 存活组71例, 死亡组11例。存活组与死亡组脓毒性休克足月儿的VIS 最大值、休克评分最大值、乳酸最大值、第2个24 h VIS平均值、第1个及第2个24 h乳酸平均值比较, 差异均有统计学意义(P<0.05);VIS 最大值(OR=1.038, 95%CI 1.014~1.063)、休克评分最大值(OR=2.372, 95%CI 1.126~4.999)和第1个24 h乳酸平均值(OR=2.983, 95%CI 1.132~7.862)均与足月儿脓毒性休克死亡结局相关(P<0.05);VIS最大值曲线下面积最大, 截断值为58.5。结论三者中, VIS对脓毒性休克足月儿死亡结局预测价值最好, 休克评分次之, 乳酸水平较差。

Objective To study the predictive value of vasoactive-inotropic score(VIS),shock score and lactate level for the outcome of term infants with septic shock.Methods From January 2019 to October 2020,clinical data of term infants with septic shock admitted to our department were reviewed.According to their clinical outcome,the infants were assigned into the survival group and the deceased group and the differences of the two groups were compared.Logistic regression was used to determine the risk factors of mortality in term infants with septic shock.Receiver operating characteristic curve was used to compare the predictive efficacy of VIS,shock score and lactate level for the outcome of septic shock.Results Significant differences existed between the survival group and the deceased group in the following:maximum VIS,maximum shock score,maximum lactate level,the mean value of VIS during the second 24 h,the mean value of lactate during the first and second 24 h(P<0.05).Meanwhile,maximum VIS(OR=1.038,95%CI 1.014~1.063),maximum shock score(OR=2.372,95%CI 1.126~4.999)and the mean value of lactate during the first 24h(OR=2.983,95%CI 1.132~7.862)were correlated with mortality in the infants(P<0.05).The area under the curve of maximum VIS was the most prominent,with 58.5 as cut-off.Conclusions Among the three indicators,VIS has the best predictive value for mortality outcome in term infants with septic shock,followed by shock score and lactate level.