老年脓毒症幸存者股四头肌厚度变化对非计划再入院的预测价值

Predictive value of quadriceps muscle thickness changes for unplanned readmission in elderly sepsis survivors

目的:探讨老年脓毒症幸存者股四头肌厚度(QMT)变化对其出院后3个月内非计划再入院的预测价值。方法:选取2020年1月—2022年3月海南医学院第二附属医院重症监护病房(ICU)收治的310例老年脓毒症幸存者为前瞻性研究随访队列,连续随访3个月,以首次非计划再入院或完成随访为观察终点。收集所有老年脓毒症幸存者的临床资料,于入ICU后24 h内和第7天时分别采用超声测量QMT,并计算QMT变化率。采用单因素分析、多因素Logistic回归分析、受试者工作特征(ROC)曲线探讨QMT变化与老年脓毒症幸存者出院后3个月内非计划再入院的关系。结果:310例老年脓毒症幸存者中,共96例病人出院后3个月内发生非计划再入院,发生率为30.97%。多因素Logistic回归分析结果显示,年龄≥75岁(OR=2.086,P=0.036)、第7天时QMT (OR=0.356,P<0.001)、QMT变化率(OR=1.368,P<0.001)是老年脓毒症幸存者发生非计划再入院的独立影响因素。ROC曲线分析结果显示,第7天时QMT、QMT变化率预测老年脓毒症幸存者出院后3个月内非计划再入院的ROC曲线下面积分别为0.758,0.877,当截断值分别为16.83 mm、6.04%时,第7天时QMT、QMT变化率预测老年脓毒症幸存者3个月内再入院的敏感度分别为82.29%、87.50%,特异度分别为64.95%、82.24%。QMT变化率的预测效能高于第7天时QMT的预测效能(Z=3.096,P=0.002)。结论:QMT能够反映老年脓毒症幸存者的肌肉质量和营养状态,QMT下降越明显,出院后3个月内非计划再入院风险越高。

Objective:To investigate the predictive value of quadriceps muscle thickness(QMT)changes in elderly sepsis survivors for unplanned readmission within 3 months after discharge.Methods:A total of 310 elderly septic survivors admitted to the intensive care unit(ICU)of the Second Affiliated Hospital of Hainan Medical University from January 2020 to March 2022 were enrolled as the prospective study follow-up cohort.Follow-up was undertaken consecutive for 3 months,and observation ended at the first unplanned readmission or completion of follow-up.The clinical data of all elderly septic survivors were collected.QMT was measured by ultrasound within 24 hours and on the 7th day after admission to ICU,and the change rate of QMT was calculated.Univariate analysis,multivariate logistic regression analysis and receiver operating characteristic(ROC)curve were used to explore the relationship between changes of QMT and unplanned readmission within 3 months after discharge in elderly septic survivors.Results:Among 310 elderly septic survivors,96 patients had unplanned readmission within 3 months after discharge,with an incidence of 30.97%.Multivariate logistic regression analysis showed that age≥75 years(OR=2.086,P=0.036),QMT on the 7th day(OR=0.356,P<0.001)and change rate of QMT(OR=1.368,P<0.001)were independent influencing factors of unplanned readmission within 3 months after discharge in older septic survivors.The ROC curve analysis results showed that the areas under the ROC curve of QMT on the 7th day and change rate of QMT for predicting the unplanned readmission within 3 months after discharge in older septic survivors were 0.758 and 0.877,respectively.When the cut-off values were 16.83 mm and 6.04%respectively,the sensitivity of QMT on the 7th day and change rate of QMT for predicting the unplanned readmission within 3 months after discharge in elderly septic survivors were 82.29%and 87.50%respectively,the specificity were 64.95%and 82.24%respectively.The predictive efficiency of change rate of QMT was significantly higher than that of QMT on the 7th day(Z=3.096,P=0.002).Conclusion:QMT can reflect the muscle mass and nutritional status of elderly septic survivors.The more obvious decrease of QMT,and the higher risk of unplanned readmission within 3 months after discharge.