多配体蛋白聚糖-1早期水平变化对老年脓毒症病人临床转归的预测价值

Predictive value of early changes of syndecan-1 for clinical outcome in elderly patients with sepsis

目的探讨多配体蛋白聚糖-1(syndecan-1,SDC-1)早期水平变化在老年脓毒症病人预后中的预测价值。方法选取2021年5月至2022年6月我院重症医学科102例老年脓毒症病人,其中28 d存活44例(存活组),死亡58例(死亡组)。疾病严重程度评估采用APACHEⅡ和序贯器官衰竭评估(SOFA)评分;观察并比较2组乳酸(Lac)、降钙素原(PCT)、肝素结合蛋白(HBP)、WBC、中性粒细胞百分比(N%)、PLT、SDC-1及3 d内SDC-1变化(ΔSDC-1)水平。采用多因素Logistic回归分析筛选影响病人预后的危险因素;绘制ROC曲线并计算AUC,评估各危险因素对老年脓毒症病人临床转归的预测价值。结果与存活组相比,死亡组APACHEⅡ评分、SOFA评分及PCT、HBP、Lac、SDC-1水平均明显升高,ΔSDC-1明显降低(P均<0.01)。多因素Logistic回归分析显示,ΔSDC-1、SOFA评分及APACHEⅡ评分为脓毒症病人28 d死亡的独立影响因素(P均<0.05)。ROC曲线分析显示,ΔSDC-1水平、APACHEⅡ评分和SOFA评分对脓毒症病人28 d死亡均有一定预测价值,其中SOFA评分预测价值最高,而ΔSDC-1水平预测价值优于APACHEⅡ评分。结论SDC-1早期水平的变化对老年脓毒症病人的死亡风险具有较高的评估价值。

Objective To investigate the predictive value of syndecan-1(SDC-1)for the prognosis in the elderly patients with sepsis.Methods A total of 102 elderly patients with sepsis in Department of Critical Medicine of our hospital from May 2021 to June 2022 were enrolled.Among them,44 cases survived(survive group)and 58 cases died(death group)within 28 days.Acute Physiology and Chronic Health Evaluation(APACHEⅡ)and Sequential Organ Failure Assessment(SOFA)were used to evaluate the severity of disease.The levels of lactate(Lac),procalcitonin(PCT),heparin-binding protein(HBP),white blood cell(WBC),neutrophil percentage(N%),platelet(PLT),SDC-1 and the decrease of syndecan-1(ΔSDC-1)in three days were observed and compared between the two groups.Multivariate Logistic regression analysis was used to explore the risk factors of the prognosis.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to evaluate the predictive value of the influencing factors in the elderly patients with sepsis.Results Compared with survival group,the APACHEⅡ score,SOFA score,and the levels of PCT,HBP,Lac and SDC-1 in death group were significantly increased,and the level of ΔSDC-1 was significantly decreased(P<0.01).ΔSDC-1,SOFA score and APACHEⅡ score were the independent risk factors for 28 d mortality in the elderly patients with sepsis(P<0.05).The ROC curve analysis showed that the predictive value of SOFA score for 28 d death in the elderly patients with sepsis was the highest,followed by ΔSDC-1 level and APACHEⅡ score.Conclusions The dynamic decline level of SCD-1 has a high value in assessing the risk of death in the elderly patients with sepsis.