纤维蛋白降解产物和D-二聚体对脓毒症休克患者近期预后的预测价值

Predictive value of fibrin degradation product and D-dimer in short-term prognosis of septic shock patients

目的探究纤维蛋白降解产物(FDP)和D-二聚体对脓毒症休克患者近期预后的预测价值。方法选取安徽省安庆市立医院2019年1月至2022年7月收治的86例脓毒症休克患者作为研究对象,根据入院28 d的生存情况将其分为生存组(65例)和死亡组(21例),比较两组临床资料及入院48 h内血清FDP、D-二聚体的差异,分析脓毒症休克患者预后的影响因素,进一步分析其对脓毒症休克患者近期预后的预测价值。结果死亡组急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、脓毒症相关性器官功能衰竭评价(SOFA)评分、FDP、D-二聚体水平均高于生存组,血小板计数低于生存组(P<0.05)。logistic多因素分析结果显示,APACHEⅡ评分(OR=4.116,95%CI:1.393~12.163)、SOFA评分(OR=4.003,95%CI:1.355~11.827)及FDP(OR=4.051,95%CI:1.371~11.970)、D-二聚体(OR=3.991,95%CI:1.351~11.792)水平均为脓毒症休克患者入院28 d内死亡的影响因素(P<0.05)。受试者操作特征曲线分析结果显示,FDP、D-二聚体联合预测脓毒症休克患者近期预后的曲线下面积高于二者单独(P<0.05)。结论FDP、D-二聚体水平与脓毒症休克患者近期预后相关,且可用于预测脓毒症休克患者入院28 d内死亡风险。

Objective To investigate the predictive value of fibrin degradation product(FDP)and D-dimer on the short-term prognosis of septic shock patients.Methods A total of 86 patients with septic shock admitted to Anqing Municipal Hospital in Anhui Province from January 2019 to July 2022 were selected as the study subjects,and they were divided into survival group(65 cases)and death group(21 cases)according to their survival conditions 28 days after admission.The clinical data and the differences of serum FDP and D-dimer within 48 h after admission were compared between the two groups,and the influencing factors of prognosis in patients with septic shock were analyzed,and their predictive value for short-term prognosis in patients with septic shock was further analyzed.Results Acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sepsis-related organ failure assessment(SOFA)score,and levels of FDP,D-dimer in death group were higher than those in survival group,and platelet count was lower than that in survival group(P<0.05).Logistic multivariate analysis results showed that APACHEⅡscore(OR=4.116,95%CI:1.393-12.163),SOFA score(OR=4.003,95%CI:1.355-11.827),and levels of FDP(OR=4.051,95%CI:1.371-11.970)and D-dimer(OR=3.991,95%CI:1.351-11.792)were the influential factors for death within 28 days of admission in septic shock patients(P<0.05).The results of receiver operation characteristic curve analysis showed that the area under the curve of FDP and D-dimer combined predicted the short-term prognosis of septic shock patients was higher than that of FDP and D-dimer alone(P<0.05).Conclusion Levels of FDP and D-dimer are associated with the short-term prognosis of patients with septic shock,and could be used to predict the risk of death within 28 days of admission.