骨骼肌脂肪变性对ICU脓毒症患者预后的预测价值

Prognostic value of skeletal muscle steatosis in the patients with sepsis in ICU

目的探究基于电子计算机扫描(CT)评估的骨骼肌脂肪变性,是否可以作为重症监护病房(ICU)脓毒症患者预后的独立危险因素。方法采用回顾性分析研究,收集并分析2019年1月至2022年1月收住南京鼓楼医院ICU的脓毒症患者的临床资料、CT影像、入院24 h内序贯器官衰竭评分(SOFA)及急性生理学与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分等。根据临床转归分为存活组和死亡组,比较两组患者基线水平及差异。采用K-M曲线分析骨骼肌脂肪变性与非脂肪变性患者生存率差异。采用多因素Logistic回归分析ICU脓毒症患者预后的独立危险因素。结果共纳入84例脓毒症患者,其中存活48例,死亡36例(病死率为42.86%)。①死亡组患者性别、骨骼肌脂肪变性比例、APACHEⅡ评分、机械通气、血乳酸、肌酸激酶与存活组比较差异均有统计学意义(P<0.05);②与非脂肪变性组总体病死率(7例,8.33%)比较,脂肪变性组(29例,34.52%)明显增多,两组病死率比较差异有统计学意义(P<0.001);③经K-M曲线分析,骨骼肌脂肪变性组患者在任何一时间点的生存率均低于非骨骼肌脂肪变性组,且经Log-Rank test检验结果显示,两组生存曲线差异有统计学意义(P<0.001)。④经多因素Logistic回归方程进行分析,患者入院时骨骼肌脂肪变性(OR=7.517,95%CI 1.639~34.473,P<0.001)和APACHEⅡ评分(OR=1.116,95%CI 1.023~1.216,P=0.013)为ICU脓毒症患者死亡的独立危险因素,且骨骼肌脂肪变性组死亡风险是非脂肪变性组患者的7.5倍。结论ICU脓毒症患者入院时的骨骼肌脂肪变性与不良预后独立相关。因此ICU脓毒症患者入院时基于CT评估的骨骼肌脂肪变性是患者不良预后的独立危险因素。

Objective To explore whether skeletal muscle steatosis based on computer tomography(CT)assessment can be an independent risk factor for the prognosis of the patients with sepsis in ICU.Methods Clinical data,CT images,sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)of sepsis patients admitted to ICU of Nanjing Drum Tower Hospital from January 2019 to January 2022 were collected and analyzed by retrospective study.According to clinical outcome,the patients were divided into survival group and death group,and the baseline level and differences between the two groups were compared.K-M curve was used to analyze the difference in survival rate between skeletal muscle steatosis and non-skeletal muscle steatosis.Multivariate Logistic regression was used to analyze the independent risk factors of sepsis patients in ICU.Results A total of 84 patients with sepsis were included,of which 48 survived and 36 died.The overall fatality rate was 42.86%.①There were significant differences in gender,proportion of skeletal muscle steatosis,APACHEⅡscore,mechanical ventilation,blood lactate level and creatine kinase between death group and survival group(P<0.05).②Compared with the non-skeletal muscle steatosis group(7 cases,8.33%),the overall mortality in the skeletal muscle steatosis group was significantly higher(29 cases,34.52%),and the difference in the mortality between the two groups was statistically significant(P<0.001).③By K-M curve analysis,the survival rate of the skeletal muscle steatosis group was lower than that of the non-skeletal muscle steatosis group at any time point,and the Log-Rank test showed that the difference in survival curve between the two groups was statistically significant(P<0.001).④Multivariate Logistic regression showed skeletal muscle steatosis(OR=7.517,95%CI 1.639-34.473,P<0.001)and APACHEⅡscore(OR=1.116,95%CI 1.023-1.216,P=0.013)on admission were independent risk factors for death of sepsis patients in ICU,and the risk of death in the skeletal muscle steatosis group was 7.5 times higher than that in the non-skeletal muscle steatosis group.Conclusions Skeletal muscle steatosis in sepsis patients on admission to ICU is independently associated with poor prognosis,and is an independent risk factor for poor prognosis.