IABP-SHOCKⅡ评分联合动脉血乳酸、RDW对心肌梗死并发心源性休克患者预后的预测价值

Predictive value of IABP-SHOCKⅡscore combined with arterial blood lactic acid and RDW on prognosis of patients with myocardial infarction complicating cardiogenic shock

目的探讨IABP-SHOCKⅡ评分联合动脉血乳酸水平、红细胞分布宽度(RDW)对心肌梗死并发心源性休克患者预后的预测价值。方法选取2019年10月至2021年10月于该院就诊的心肌梗死并发心源性休克患者68例,按患者28 d后的生存情况分为良好组(49例)和死亡组(19例)。比较两组患者IABP-SHOCKⅡ评分、动脉血乳酸水平、红细胞计数(RBC)、白细胞计数(WBC)、红细胞分布宽度(RDW)、血小板计数(PLT),采用Logistic回归模型分析心肌梗死并发心源性休克患者死亡的影响因素,并采用受试者工作特征(ROC)曲线分析IABP-SHOCKⅡ评分联合动脉血乳酸和RDW对心肌梗死并发心源性休克患者死亡的预测效能。结果良好组的IABP-SHOCKⅡ评分、动脉血乳酸水平、WBC、RDW及PLT均显著低于死亡组,差异均有统计学意义(P<0.05)。Logistic回归分析显示,WBC和PLT不是心肌梗死并发心源性休克患者死亡的影响因素(P>0.05),IABP-SHOCKⅡ评分、动脉血乳酸水平和RDW是心肌梗死并发心源性休克患者死亡的独立影响因素(P<0.05)。IABP-SHOCKⅡ评分、动脉血乳酸水平、RDW预测心肌梗死并发心源性休克患者死亡的AUC分别为0.834(95%CI:0.724~0.913)、0.800(95%CI:0.685~0.887)、0.793(95%CI:0.677~0.882),IABP-SHOCKⅡ评分、动脉血乳酸水平、RDW联合预测心肌梗死并发心源性休克患者死亡的AUC为0.943(95%CI:0.859~0.985),联合检测的预测效能高于单项检测。结论IABP-SHOCKⅡ评分联合动脉血乳酸水平、RDW对心肌梗死并发心源性休克患者的死亡有一定的预测价值。

Objective To explore the predictive value of IABP-SHOCKⅡscore combined with arterial blood lactic acid level and red blood cell distribution width(RDW)on the prognosis of the patients with myocardial infarction complicating cardiogenic shock.Methods Sixty-eight patients with myocardial infarction complicating cardiogenic shock treated in this hospital from October 2019 to October 2021,were selected and divided into the good group(49 cases)and death group(19 cases)according to the survival situation after 28 d.The IABP-SHOCKⅡscore,arterial blood lactic acid level,red blood cell count(RBC),white blood cell count(WBC),RDW and platelet count(PLT)were compared between the two groups.The influencing factors of death in the patients with myocardial infarction complicating cardiogenic shock were analyzed by the Logistic regression model.The predictive efficiency of IABP-SHOCKⅡscore combined with arterial blood lactic acid level and RDW on the death occurrence in the patients with myocardial infarction complicating cardiogenic shock was analyzed by the receiver operating characteristic(ROC)curve.Results The IABP-SHOCKⅡscore,arterial blood lactic acid level,WBC,RDW and PLT in the good group were significantly lower than those in the death group,and the differences were statistically significant(P<0.05).The Logistic regression analysis showed that WBC and PLT were not the influencing factors of the death in the patients with myocardial infarction complicating cardiogenic shock(P>0.05),and the IABP-SHOCKⅡscore,arterial blood lactic acid level and RDW were the independent influencing factors of the death in the patients with myocardial infarction complicating cardiogenic shock(P<0.05).The areas under the curves(AUC)of IABP-SHOCKⅡscore,arterial blood lactic acid level and RDW in predicting the death of the patients with myocardial infarction complicating cardiogenic shock were 0.834(95%CI:0.724-0.913),0.800(95%CI:0.685-0.887)and 0.793(95%CI:0.677-0.882)respectively,and AUC of the combination detection of IABP-SHOCKⅡscore,blood lactic acid level and RDW in predicting the death of the patients with myocardial infarction complicated with cardiogenic shock was 0.943(95%CI:0.859-0.985),and the predictive efficiency of combined detection was higher than that of single item detection.Conclusion The IABP-SHOCKⅡscore combined with arterial blood lactic acid and RDW has a certain predictive value on the death of patients with myocardial infarction complicating cardiogenic shock.