血清可溶性人基质裂解素-2联合左室舒张功能指标对老年脓毒症休克患者预后评估价值

Prognostic value of serum concentration of human soluble stromelysin-2 combined with left ventricular diastolic function for elderly patients with septic shock

目的探索血清可溶性人基质裂解素-2(sST2)联合超声左室舒张功能指标早期对老年脓毒症休克患者预后的预测价值。方法采用前瞻性研究方法,选取2019年5月至2022年5月嘉兴市第一医院ICU收治的150例老年脓毒症休克患者作为研究对象。所有患者在入ICU第1、3、5和7天进行sST2,二尖瓣舒张早期峰值流速(E),二尖瓣舒张晚期峰值流速(A),E/A,二尖瓣环舒张早期峰值流速(e’)及E/e’等检测。根据随访获得患者28 d预后结局,将患者分为存活组及死亡组,比较上述指标在不同组别及不同时间点间的差异。采用Logistic回归法分析老年脓毒症休克患者28 d死亡的独立危险因素,受试者工作特征曲线(ROC)评估其对老年脓毒症休克患者28 d死亡的预测价值,并根据最佳截断值进行危险分层,比较不同危险分层下28 d病死率的差异,采用Kaplan-Meier生存曲线比较不同危险分层下28 d累积生存率。分析联合指标对老年脓毒症休克患者28 d病死率的预测价值。结果入ICU第5天死亡组e’低于存活组,E/e’和sST2高于存活组。单因素和多因素Logistic回归分析显示sST2(OR=1.010,P<0.001)为老年脓毒症休克患者28 d死亡的独立危险因素。sST2预测老年脓毒症休克患者28 d死亡的敏感度为50.2%,特异性为79.1%,AUC为0.660。入ICU第5天sST2为89.3μg/L作为预测老年脓毒症休克患者28 d死亡的临床诊断临界点。基于sST2水平危险分层显示,与sST2≤89.3μg/L组相比,sST2>89.3μg/L组28 d病死率更高;Kaplan-Meier生存分析显示,sST2>89.3μg/L组28 d累积生存率显著低于sST2≤89.3μg/L组(44.0%比66.7%;Log-Rank检验:χ^(2)=9.101,P=0.003)。ROC曲线显示,sST2、e’和E/e’三者联合显著提高老年脓毒症休克患者28 d病死率预测效能,AUC为0.844,敏感度是89.7%,特异性是66.5%。结论sST2是老年脓毒症休克患者28 d死亡的独立危险因素,联合e’和E/e’指标能早期更加准确评估老年脓毒症休克患者生存预后。

Objective To explore the prognostic value of the serum concentration of human soluble stromelysin-2(sST2)combined with ultrasonic left ventricular diastolic function parameters for elderly patients with septic shock.Methods This prospective study involved 150 elderly patients with septic shock admitted to the intensive care unit(ICU)of the First Hospital of Jiaxing between May 2019 and May 2022.Data on the following parameters were recorded on days 1,3,5,and 7 in the ICU:sST2 concentration,mitral early-diastolic inflow peak velocity(E),mitral late-diastolic inflow peak velocity(A),E/A ratio,early diastolic mitral annular velocity(e'),and E/e'ratio.According to the 28-day prognostic outcome obtained during follow-up,patients were divided into a survival group and a death group to compare differences in values of the above parameters between the two groups and at different time points.Logistic regression was used to analyze independent risk factors for 28-day mortality.The receiver operating characteristic(ROC)curve was used to analyze the predictive value for 28-day mortality,and further risk stratification was performed according to optimal cut-off values to compare differences in 28-day mortality under different risk stratification methods.The Kaplan-Meier survival curve was used to compare 28-day cumulative survival under different risk stratification methods and analyze the predictive value of the combination of the parameters for 28-day mortality.Results On day 5 following ICU admission,e'was lower and E/e'and sST2 were higher in the death group than in the survival group.Univariate and multivariate Logistic regression analysis suggested that sST2(odds ratio:1.010,P<0.001)was an independent risk factor for 28-day mortality in elderly patients with septic shock.sST2 had a sensitivity of 50.2%,a specificity of 79.1%,and an area under the curve of 0.660 for predicting 28-day mortality in patients with septic shock.The sST2 concentration was 89.3μg/L on day 5 after ICU admission,which was the clinical cutoff point for predicting 28-day mortality.Based on the risk stratification of sST2 levels,the 28-day mortality rate was higher in the sST2>89.3μg/L group than in the sST2≤89.3μg/L group.Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate was significantly lower in the sST2>89.3μg/L group than in the sST2≤89.3μg/L group(44.0%vs.66.7%,log-rank test: χ^(2)=9.101,P=0.003).The receiver operating characteristic curve showed that the combination of sST2,e',and E/e'significantly improved the prediction efficiency of 28-day mortality in elderly patients with septic shock,with an area under the curve of 0.844,a sensitivity of 89.7%,and a specificity of 66.5%.Conclusions sST2 is an independent risk factor for 28-day mortality in elderly patients with septic shock.When combined with e'and E/e',sST2 can more accurately evaluate the survival prognosis of these patients.