脓毒症休克患者复苏早期氧摄取率与预后的相关性

Relationship between Oxygen Extraction Ratio and Prognosis in Septic Shock Patients During Early Resuscitation

目的 评估复苏早期氧摄取率(Oxygen extraction ratio, ERO_(2))对脓毒症休克患者ICU预后的影响。方法回顾性纳入2016年1月—2021年7月北京协和医院重症医学科脓毒症休克患者,并根据ICU预后将其分为生存组和死亡组。收集患者基线临床资料及复苏后6 h氧代谢相关指标,包括氧输送(Oxygen delivery, DO_(2))、氧消耗(Oxygen consumption, VO_(2))、ERO_(2)、乳酸(lactate, Lac)。采用多因素Logistic回归分析脓毒症休克患者ICU死亡的危险因素,并采用受试者工作特征(receiver operating characteristic, ROC)曲线评估各指标对脓毒症休克患者ICU死亡的预测价值。结果 共入选符合纳入与排除标准的脓毒症休克患者73例,其中死亡组21例,生存组52例。两组急性生理学和慢性健康状况Ⅱ评分、序贯器官衰竭估计评分差异具有统计学意义(P均<0.05)。相较于生存组,死亡组复苏后6 h Lac [5.6(4.2,10.0)mmol/L比3.4(2.1, 6.9)mmol/L,P=0.009]、VO_(2)[(165±95) mL/(min·m^(2))比(106±58)mL/(min·m^(2)),P=0.012]、ERO_(2)[(56.56±19.48)%比(33.71±13.24)%,P=0.000]均升高,两组DO_(2)无显著差异[266(214,384)mL/(min·m^(2))比300(250,396) mL/(min·m^(2)),P=0.159]。多因素Logistic回归分析结果显示,ERO_(2)是脓毒症休克患者ICU死亡的独立危险因素(OR=1.126,95%CI:1.053~1.203,P=0.000)。ROC曲线显示,ERO_(2)预测脓毒症休克患者ICU死亡的曲线下面积(area under the curve, AUC)为0.833,最佳临界值为45.93%,灵敏度为76.19%,特异度为94.23%,其预测效能优于急性生理学和慢性健康状况Ⅱ评分(AUC:0.704)、序贯器官衰竭估计评分(AUC:0.778)和Lac(AUC:0.668)。结论 复苏早期ERO_(2)升高可增加脓毒症休克患者ICU死亡风险,具有良好的预后预测价值。

Objective To investigate the relationship between Oxygen extraction ratio(ERO_(2))prognosis of septic shock patients in the early stage of resuscitation.Methods The data of the patients with septic shock admitted to the department of Critical Care Medicine of Peking Union Medical College Hospital from January 2016 to July 2021 were retrospectively collected.The patients were divided into the survival group and the death group according to the prognosis of the ICU.The baseline data,and Oxygen metabolism indexes including Oxygen delivery(DO_(2)),Oxygen consumption(VO_(2)),ERO_(2) and lactate(Lac)of the two groups were collected.Risk factors for ICU death in patients with septic shock were analyzed using multi-factorial Logistic regression,and the predictive value of each indicator for ICU death in patients with septic shock was assessed using receiver operating characteristic(ROC)curves.Results A total of 73 patients with septic shock who met the inclusion and exclusion criteria were enrolled,including 21 cases in the death group and 52 cases in the survival group.The differences in acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores and sequential organ failure assessment(SOFA)scores between the two groups were statistically significant(all P<005).Compared with the survival group,6 h after resuscitation in the death group,Lac[56(42,100)mmol/L vs 34(21,69)mmol/L,P=0009],VO_(2)[(165±95)mL/(min·m^(2))vs(106±58)mL/(min·m^(2)),P=0012],ERO_(2)[(5656±1948)%vs(3371±1324)%,P=0000]were elevated,and there was no significant difference in DO_(2) between the two groups[266(214,384)mL/(min·m^(2))vs 300(250,396)mL/(min·m^(2)),P=0159].The results of multifactorial Logistic regression analysis showed that ERO_(2) was an independent risk factor for ICU death in patients with septic shock(OR=1126,95%CI:1053-1203,P=0000)The ROC curve showed that the area under the curve(AUC)of ERO_(2) for predicting ICU death in septic shock patients was 0833,with an optimal threshold of 4593%,sensitivity of 7619%,specificity of 9423%,and its predic-tive efficacy was superior to that of the APACHEⅡscores(AUC:0704),SOFA score(AUC:0778),and Lac(AUC:0668).Conclusion ERO_(2) in the early stage of septic shock resuscitation is an independ-ent risk factor for ICU prognosis,which has a good predictive value for the prognosis of septic shock.