老年脓毒症患者血清转铁蛋白与预后相关性研究

A study on the relationship between serum transferrin and prognosis of elderly patients with sepsis

目的探讨血清转铁蛋白(TRF)与老年脓毒症患者病情及预后的相关性。方法回顾性分析,收集2020年10月至2022年3月苏州大学附属第一医院重症医学科和呼吸与危重症医学科符合纳入标准的49例老年脓毒症患者(脓毒症组),根据是否发生休克分为休克组(18例)和非休克组(31例),是否死亡分为死亡组(16例)和存活组(33例);通过随机数字表法抽取我院体检中心体检的健康老年人30例为对照组。对入院第1、3、7天的TRF、铁蛋白进行检测,分析TRF与序贯器官衰竭评估评分(SOFA)的相关性,用受试者工作特征曲线评估TRF对预后的预测价值,二元Logistic回归模型分析多因素对预后的影响。结果老年脓毒症患者入院时铁蛋白与对照组相比升高[709.20(402.40,2000.00)μg/L比102.05(79.55,199.75)μg/L];入院时TRF组与对照组相比降低[1.43(1.12,1.72)g/L比2.23(1.80,3.12)g/L],差异均有统计学意义(Z值分别为-5.482、5.395,均P<0.01)。休克组患者第3天、第7天TRF值低于非休克组,(1.25±0.35)g/L比(1.55±0.51)g/L(t=-2.186)、1.15(9.68,1.34)g/L比1.56(1.19,2.03)g/L(Z=3.258),均P<0.05;第1天、第3天、第7天TRF与SOFA评分呈线性相关(R2值分别为0.177、0.176、0.275,均P<0.01)。死亡组第3天、第7天TRF低于存活组(Z=2.208、3.423,均P<0.05)。老年脓毒症患者第3天、第7天TRF水平对评估预后有预测价值,受试者工作特征曲线下面积(AUC)分别为0.696、0.804(P<0.05、P<0.01),分别以最佳截断值第3天TRF=1.085 g/L和第7天TRF=1.330 g/L为界,两组生存曲线差异有统计学意义(χ^(2)值分别为10.903、13.318,均P<0.01);老年脓毒症患者第3天TRF<1.085 g/L时第28天的死亡风险为9.388倍(OR=9.388,P<0.01),老年脓毒症患者第7天TRF<1.330g/L时第28天的死亡风险为14.625倍(OR=14.625,P<0.01)。结论老年脓毒症患者铁蛋白升高与病情无关;TRF水平与病情轻重相关;老年脓毒症患者第3天、第7天TRF水平与预后相关,是第28天全因死亡的独立危险因素。

Objective To investigate the relationship between serum transferrin(TRF)and the characteristics and prognosis of elderly patients with sepsis.Methods A retrospective analysis was conducted on 49 elderly patients with sepsis treated at the Department of Critical Medicine and the Department of Respiratory and Critical Medicine of the First Affiliated Hospital of Suzhou University between October 2020 and March 2022 who had met the inclusion criteria.These patients were divided into a shock group(n=18)and a non-shock group(n=31);Based on outcomes,they were also divided into a death group(n=16)and a survival group(n=33).Through the random number table method,30 healthy elderly people from the physical examination center of our hospital were selected as the control group.TRF and ferritin(SF)were measured on the 1st,3rd and 7th day after admission,and the correlation between TRF and the sequential organ failure assessment score(SOFA)was analyzed.The predictive value of TRF on prognosis was evaluated via the receiver operating characteristic curve.Finally,the influence of multiple factors on prognosis was analyzed using the binary logistic regression model.Results Compared with the control group at admission,SF levels of elderly patients with sepsis increased[709.20(402.40,2000.00)μg/L vs.102.05(79.55,199.75)μg/L,Z=-5.482,P<0.01],but TRF levels decreased[1.43(1.12,1.72)g/L vs.2.23(1.80,3.12)g/L,Z=5.395,all P<0.01],with statistical significance.On the 3rd and 7th day,TRF levels in the shock group were lower than in the non-shock group[(1.25±0.35)g/L vs.(1.55±0.51)g/L,1.15(9.68,1.34)g/L vs.1.56(1.19,2.03)g/L](t=-2.186,Z=3.258,P<0.05).There was a linear correlation between TRF and SOFA score on the 1st,3rd and 7th day(R2=0.177,0.176,0.275,all P<0.01).TRF levels in the death group were lower than in the survival group on the 3rd and 7th day(Z=2.208,3.423,P<0.05 for both).TRF levels on the 3rd and 7th day in elderly patients with sepsis had predictive value in evaluating the prognosis[area under receiver operating characteristic curve(AUC)values=0.696,0.804,P<0.05,P<0.01].The survival curves based upon the best cutoff values(TRF=1.085 g/L on the 3rd day,TRF=1.330 g/L on the 7th day)between the two groups were statistically significantly(χ^(2)=10.903,13.318,P<0.01 for both).With TRF<1.085 g/L on the 3rd day,the risk of death in elderly patients with sepsis on the 28th day was 9.388 times the usual risk(OR=9.388,P<0.01),and with TRF<1.330 g/L on the 7th day,the risk of death was 14.625 times the usual risk on the 28th day(OR=14.625,P<0.01).Conclusions Increased SF in elderly patients with sepsis is not related to disease severity,but the level of TRF is related to disease severity,and the level of TRF on the 3rd and 7th day is related to the prognosis and is an independent risk factor for all-cause death on the 28th day.