脓毒症休克患者预后影响因素研究

Study the influence factors of treatment prognosis in septic shock patients

目的探讨血常规指标及脓毒症相关器官功能障碍(SOFA)评分对急诊快速评估脓毒症休克预后的价值,以及影响脓毒症休克患者预后的因素。方法回顾性分析自2020年1月至2022年4月首都医科大学宣武医院收治的105例脓毒症休克患者的临床资料,并按照预后结局,将其中77例存活者归于预后良好组,另28例院内死亡者归于预后不良组。收集并比较所有患者的临床资料;测定两组血肌酐(Cr)、中性粒细胞计数、淋巴细胞计数、血小板计数(PLT),计算淋巴细胞与PLT比值(LPR)、中性粒细胞与LPR比值(N/LPR);记录原发感染疾病部位。应用Logistic回归分析影响脓毒症休克患者预后的因素。采用受试者工作特征(ROC)曲线评估各指标对脓毒症休克患者院内死亡的预测价值。结果两组患者的性别、原发感染部位、糖尿病患者比例比较,差异均无统计学意义(P>0.05);但预后不良组患者的年龄、SOFA评分、Cr、LPR、N/LPR均高于预后良好组,差异均有统计学意义(P<0.05)。Logistic多因素回归分析结果显示,年龄、SOFA、N/LPR是影响脓毒症休克患者预后的独立因素。ROC曲线分析显示,年龄、SOFA评分、Cr、N/LPR预测脓毒症休克患者死亡的曲线下面积分别为0.747、0.767、0.725、0.838。结论年龄、SOFA评分、Cr、N/LPR对脓毒症休克患者死亡有更好的预测价值。

Objective To investigate the value of blood routine indexes and sepsis-related organ failure assessment(SOFA)score in rapid prognosis assessment of septic shock in emergency department,and the factors affecting prognosis of septic shock patients.Methods The clinical data of 105 patients with septic shock enrolled in Xuanwu Hospital Capital Medical University from January 2020 to April 2022 were retrospectively analyzed.According to the prognosis,77 survivors were classified into the good prognosis group,and the other 28 patients who died in hospital were classified into the poor prognosis group.Collect and compare clinical data of all patients.Serum creatinine(Cr),neutrophil count,lymphocyte count and platelet count(PLT)were measured in both groups.Lymphocyte to PLT ratio(LPR)and neutrophil to LPR ratio(N/LPR)were calculated.The site of primary infection was recorded.Logistic regression was used to analyze the prognostic factors of septic shock patients.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of each index for hospital death in septic shock patients.ResulstsTherewere no significant differences in gender,primary infection site and proportion of diabetic patients between the two groups(P>0.05).However,the age,SOFA score,Cr,LPR and N/LPR of patients in the poor prognosis group were higher than those in the good prognosis group,with statistical significance(P<0.05).Logistic multivariate regression analysis showed that age,SOFA and N/LPR were independent factors affecting the prognosis of septic shock patients.ROC curve analysis showed that the area under the curve of age,SOFA score,Cr and N/LPR in predicting the death of septic shock patients were 0.747,0.767,0.725 and 0.838,respectively.ConclusioAnge,SOFA score,Cr,N/LPR have better predictive value for the death of septic shock patients.