APACHE Ⅱ联合SOFA评分对肺炎克雷伯菌致脓毒症预后的评估价值

Prognostic Value of APACHEⅡ Combined with SOFA Score in Patients with Klebsiella Pneumoniae Induced Sepsis

目的探讨肺炎克雷伯菌致脓毒症患者预后的影响因素,并分析急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分联合器官衰竭(sequential organ failure assessment,SOFA)评分对预后的评估价值。方法选取2018年1月至2020年8月安徽皖北煤电集团总医院收治的肺炎克雷伯菌致脓毒症患者183例作为研究对象,根据患者预后情况分为存活组(137例)和死亡组(46例)。比较两组患者一般临床资料和疾病相关指标的差异,应用多因素Logistic回归分析肺炎克雷伯菌致脓毒症患者预后的影响因素。绘制受试者工作特征(ROC)曲线分析APACHEⅡ、SOFA评分对预后的评价价值。结果存活组患者的年龄、降钙素原(PCT)、C-反应蛋白(CRP)、血尿素氮(BUN)、血清肌酐(Scr)、APACHEⅡ评分、SOFA评分、急性肾衰竭比例及心力衰竭比例均低于死亡组(P均<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分(OR=2.125)、SOFA评分(OR=1.866)、年龄(OR=1.573)、CRP(OR=1.745)均是肺炎克雷伯菌致脓毒症患者死亡的影响因素(P均<0.05)。APACHEⅡ评分、SOFA评分预测肺炎克雷伯菌致脓毒症患者死亡的ROC曲线下面积(AUC)分别为0.792、0.782,二者联合诊断的AUC为0.873,高于任一单项指标。结论APACHEⅡ评分、SOFA评分、年龄、CRP升高均是肺炎克雷伯菌致脓毒症患者死亡的危险因素,APACHEⅡ联合SOFA评分有助于患者死亡的早期预测评估。

Objective To investigate the prognostic risk factors of klebsiella pneumoniae induced sepsis,and to analyze the prognostic value of acute physiology and chronic health evaluationⅡ(APACHEⅡ)score combined with sequential organ failure assessment(SOFA)score.Methods A total of 183 patients with sepsis caused by Klebsiella pneumoniae who were followed up in our hospital from January 2018 to August 2020 were selected as study subjects,and were divided into the survival group(137 cases)and the death group(46 cases)according to the prognosis of the patients.The differences in general clinical data and disease-related indicators between the two groups were compared.Logistic regression analysis was used to analyze the risk factors of prognosis in patients with klebsiella pneumoniae induced sepsis.ROC was drawn to analyze the prognostic value of APACHEⅡand SOFA scores.Results Age,procalcitonin(PCT),C-reactive protein(CRP),blood urea nitrogen(BUN),creatinine(Scr),APACHEⅡscore,SOFA score,acute kidney failure ratio and heart failure ratio were significantly lower in the survival group than in the death group(P all<0.05).Logistic multivariate regression analysis showed that APACHEⅡscore(OR=2.125),SOFA score(OR=1.866),age(OR=1.573)and CRP(OR=1.745)were all risk factors for death in patients with klebsiella pneumoniae induced sepsis(P all<0.05).The areas under ROC(AUC)of APACHEⅡscore and SOFA score for predicting the death of patients with klebsiella pneumoniae induced sepsis were 0.792 and 0.782 respectively,and the AUC of the combined diagnosis of the two was 0.873,higher than any single indicator.Conclusion APACHEⅡscore,SOFA score,age,and CRP are all high risk factors for death in patients with klebsiella pneumoniae induced sepsis,and APACHEⅡcombined with SOFA score is helpful for early prediction and assessment of death in patients.