PCT清除率联合前白蛋白评估老年脓毒症患者的预后价值

Prognostic value of PCT clearance combined with prealbumin in elderly patients with sepsis

目的探讨降钙素原(PCT)清除率、前白蛋白在老年脓毒症患者疾病严重程度和预后中的评估价值。方法回顾性分析2020年1月至2022年1月南京市中医院重症医学科收治的老年脓毒症患者的临床资料。根据器官功能障碍程度分为单器官功能障碍组及多器官功能障碍组,根据患者是否院内死亡分为生存组及死亡组,分别比较2组患者相关血清指标,探讨相关血清指标与器官功能障碍程度及预后的相关性;Logistic回归分析发生多器官功能障碍及院内死亡的危险因素;绘制受试者工作特征曲线(ROC),评估上述指标对院内死亡的预测效能。结果最终纳入103例老年脓毒症患者,与单器官功能障碍组比较,多器官功能障碍组急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、C反应蛋白(CRP)、PCT、白介素-6(IL-6)、血小板计数(PLT)、乳酸(Lac)水平显著升高(P<0.05);Logistic多因素回归结果提示,并发血流感染(OR=42.79,95%CI:2.158~848.7)、APACHEⅡ评分(OR=1.123,95%CI:1.024~1.232)为发生多器官功能障碍的危险因素。与生存组比较,死亡组PCT、IL-6、Lac、APACHEⅡ评分、序贯器官衰竭评分(SOFA)明显高于生存组,PLT、第3天PCT清除率(PCTc3)、第7天PCT清除率(PCTc7)、前白蛋白明显低于生存组(P<0.05);Logistic回归分析发现,SOFA评分(OR=1.349,95%CI:1.071~1.700)是老年脓毒症患者院内死亡的危险因素,PCTc7(OR=0.535,95%CI:0.320~0.894)、前白蛋白(OR=0.984,95%CI:0.971~0.998)为老年脓毒症患者院内死亡的保护因素(P<0.05);ROC曲线分析以PCTc7、前白蛋白和SOFA评分为预测变量,预测院内死亡的ROC曲线下面积(AUC)分别为0.697(95%CI:0.588~0.805,P=0.001)、0.644(95%CI:0.531~0.757,P=0.015)和0.748(95%CI:0.646~0.850,P=0.000),而在SOFA评分基础上联合前白蛋白及PCTc7预测院内死亡价值最大(AUC=0.877,95%CI:0.804~0.951,P=0.000)。结论合并血流感染是老年脓毒症发生多器官功能障碍的危险因素,在SOFA评分基础上联合PCTc7、前白蛋白指标可显著提升对老年脓毒症院内死亡风险的预测,可作为临床预后判断的良好指标。

Objective To explore the evaluation value of PCT clearance,prealbumin on the severity and prognosis of elderly patients with sepsis.Methods Elderly patients with sepsis from Nanjing Hospital of Chinese Medicine in January 2020 to January 2022 were included.According to the degree of organ dysfunction,elderly patients were divided into single organ dysfunction group and multiple organ dysfunction group.And elderly patients were divided into survival group and death group according to prognosis in hospital.The differences in various indicators oftwo groups were compared.Logistic stepwise regression was used to screen out the risk factors of multiple organ dysfunction and mortality in hospital.Receiver operating characteristic curve(ROC)was drawn to evaluate the predictive efficacy of related indicators for in-hospital mortality.Results 103 elderly patients with sepsis were enrolled.Compared with the single organ dysfunction group,APACHEⅡscore,CRP,PCT,IL-6,PLT and Lac level of multiple organ dysfunction group were increased significantly(P<0.05).Logistic stepwise regression showed that bloodstream infection(OR=42.79,95%CI:2.158-848.7)and APACHEⅡscore(OR=1.123,95%CI:1.024-1.232)were risk factors of multiple organ dysfunction.Compared with the survival group,APACHEⅡscore,SOFA score,PCT,IL-6 and Lac level of death group wereincreased significantly,while PLT,PCTc3,PCTc7 and prealbumin level decreased significantly(P<0.05).Logistic stepwise regression showed thatSOFA score(OR=1.349,95%CI:1.071-1.700)was a risk factor for in-hospital mortality in elderly patients with sepsis,while PCTc7(OR=0.535,95%CI:0.320-0.894)and prealbumin(OR=0.984,95%CI:0.971-0.998)were protective factors(P<0.05).ROC curve analysis showed thatPCTc7,prealbuminand SOFA could predict the prognosis of elderly sepsis patients,the area under ROC curve(AUC)were0.697(95%CI:0.588-0.805,P=0.001),0.644(95%CI:0.531-0.757,P=0.015)and 0.748(95%CI:0.646-0.850,P=0.000),the combination of prealbumin and PCTc7 on the basis of SOFA score had the greatest value(AUC=0.877,95%CI:0.804-0.951,P=0.000).Conclusion Bloodstream infection is an independent risk factor for multiple organ dysfunction in elderly patients with sepsis.The combination of PCTc7 and prealbumin on the basis of SOFA score can significantly improve the prediction of the risk of hospital death in senile sepsis,and can be used as good indicators for clinical prognosis.