红细胞压积和抗凝血酶Ⅲ联合APACHEⅡ评分在老年脓毒症患者90天预后中的评估价值

Evaluation value of hematocrit and antithrombinⅢcombined with APACHEⅡscore in 90 day prognosis of elderly patients with sepsis

目的探讨生物标记物及预后评分在老年脓毒症患者90 d内死亡的预测价值,指导临床预后评估。方法纳入2021年6月1日—2022年7月31日上海市第一人民医院重症监护病房(ICU)收治的90例老年脓毒症患者作为研究对象。收集患者人口学及基本临床资料,记录诊断为脓毒症后24 h内生物标记物指标。根据患者90 d内是否存活分为存活组(63例)和死亡组(27例),比较2组临床特征和实验室检查的差异。采用多因素Logistic回归法分析老年脓毒症患者90 d内死亡的独立危险因素。进一步绘制受试者工作特征曲线(ROC曲线),评估独立危险因素对预后的价值。结果(1)90 d内存活的患者63例(70%),死亡27例(30%)。既往有慢性基础肺病或主要致病菌为革兰阴性菌或真菌患者预后更差(P<0.05)。死亡组入院时SOFA评分和APACHEⅡ评分更高(P<0.01)。(2)死亡组患者的红细胞压积(HCT)、抗凝血酶Ⅲ(AT-Ⅲ)较存活组降低(P<0.01)。死亡组患者的尿素氮(BUN)、谷丙转氨酶(ALT)、心房钠尿肽(BNP)、D-二聚体(D-D)、凝血酶原时间(PT)、部分活化的凝血酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(Fib)较存活组升高(P<0.05)。(3)APACHE评分Ⅱ升高、HCT降低、AT-Ⅲ降低是发生脓毒症90 d预后的独立危险因素,HCT+AT-Ⅲ+APACHEⅡ三者联合预测老年脓毒症患者90 d预后的曲线下面积为(AUC)为0.871(95%CI 0.781~0.951),敏感度为87.5%,特异度为71.4%。结论老年脓毒症患者死亡率高,预后差。HCT降低、AT-Ⅲ降低、APACHEⅡ评分升高是发生脓毒症90 d预后的独立危险因素。其中HCT+AT-Ⅲ+APACHEⅡ三者联合检测对老年脓毒症患者90 d预后的评估具有良好的预测价值。

Objective To investigate the value of biomarkers and prognostic scores in predicting death of elderly patients with sepsis within 90 days,and guide the clinical prognosis assessment.Methods 90 elderly patients with sepsis admitted to the Intensive Care Unit(ICU)of First People’s Hospital of Shanghai City from June 1,2021 to July 31,2022 were included as research subjects.The demographic and basic clinical data of the patients were collected,and their biomarkers within 24 hours after the diagnosis of sepsis were recorded.They were divided into survival group(n=63)and death group(n=27)according to whether they survived within 90 days.The differences of clinical characteristics and laboratory tests between the two groups were compared.Multivariate logistic regression was used to analyze the independent risk factors of death within 90 days in elderly patients with sepsis.The receiver operating characteristic(ROC)curve was further drawn to evaluate the prognostic value of independent risk factors.Results(1)63 patients(70%)survived and 27 ones(30%)died within 90 days.The prognosis of patients with chronic basic lung disease or whose main pathogenic bacteria were Gram-negative bacteria or fungi was worse(P<0.05).The SOFA score and APACHEⅡscore were higher in the death group on admission(P<0.01).(2)The hematocrit(HCT)and antithrombinⅢ(AT-Ⅲ)of the death group were significantly lower than those of the survival group(P<0.01).The blood urea nitrogen(BUN),alanine aminotransferase(ALT),atrial natriuretic peptide(BNP),D-dimer(D-D),prothrombin time(PT),partially activated thrombin time(APTT),international normalized ratio(INR)and fibrinogen(Fib)of the death group were significantly higher than those of the survival group(P<0.05).(3)Increased APACHEⅡscore,decreased HCT and decreased AT-Ⅲscore were independent risk factors for 90-day prognosis of sepsis.The area under the curve(AUC)of HCT+AT-Ⅲ+APACHEⅡin predicting the 90-day prognosis of elderly patients with sepsis was 0.871(95%CI 0.781-0.951),with a sensitivity of 87.5%and a specificity of 71.4%.Conclusion Elderly patients with sepsis have high mortality and poor prognosis.Decreased HCT,decreased AT-Ⅲ,and increased APACHEⅡscore are independent risk factors for 90-day prognosis of sepsis.The combined detection of HCT,AT-Ⅲand APACHEⅡscore has a good value in predicting the 90-day prognosis of elderly patients with sepsis.