SAPS-Ⅱ评分联合不同时刻乳酸清除率对脓毒症患者死亡的预测研究

Prediction of mortality in sepsis patients using simplified acute physiology scoreⅡscore combined with lactate clearance rates at different moments

目的探讨简化急性生理学评分Ⅱ(simplified acute physiology scoreⅡ,SAPS-Ⅱ)联合不同时刻乳酸清除率(lactic clearance rate,LCR)对脓毒症患者死亡的预测价值。方法选取锦州医科大学附属第一医院2020年4月—2023年2月收治的188例脓毒症患者,采用SAPS-Ⅱ量表评价,另于基线、6 h后、12 h后、24 h后、48 h后采用分光光度法检测血乳酸,并计算6 h、12 h、24 h、48 h LCR。根据28 d内存活情况分为存活组(n=139)和死亡组(n=37),采用Logistic回归分析探讨脓毒症死亡的危险因素,受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析SAPS-Ⅱ评分联合不同时刻LCR预测患者死亡的效能。结果有12例患者脱落,余176例患者中有37例死亡,病死率为21.02%。死亡组年龄、体温、随机血糖、血尿素氮、血肌酐、SAPS-Ⅱ评分均显著高于存活组(P<0.05),血小板计数和各时刻LCR均显著低于存活组(P<0.05)。死亡组LCR随着时间的延长不断下降,存活组变化趋势正相反,且两组每2个时刻间比较差异均有统计学意义(P<0.05)。SAPS-Ⅱ评分、各时刻LCR均是患者死亡的影响因素(P<0.05),SAPS-Ⅱ评分与各时刻LCR均可预测患者死亡,且联合预测的ROC曲线下面积为0.921(95%置信区间0.825~1.000),高于单独预测、各时刻LCR联合SAPS-Ⅱ评分预测(P<0.05)。结论SAPS-Ⅱ评分、不同时刻LCR均与脓毒症患者死亡有关,且上述指标联合预测死亡的效能较高。

Objective To explore the predictive value of simplified acute physiological scoreⅡ(SAPS-Ⅱ)combined with lactate clearance rates(LCR)at different moments for mortality in sepsis patients.Methods A total of 188 patients with sepsis admitted in the hospital from April 2020 to February 2023 were selected,who were evaluated using the SAPS-Ⅱscale.Spectrophotometry was used to detect blood lactate at baseline,after 6h,12h,24h,and 48h,then the LCR after 6h,12h,24h,and 48h were calculated.The patients were divided into a survival group(n=139)and a death group(n=37)based on 28 day outcome.Logistic regression analysis was used to explore the risk factors of sepsis death,and the efficacy of SAPS-Ⅱscores combined with LCR at different moments in predicting patient death was analyzed using receiver operating characteristic(ROC)curve.Results Twelve patients fell off,and 37 died in the remaining 176 patients,the mortality rate was 21.02%.The age,temperature,random blood glucose,blood urea nitrogen,serum creatinine,and SAPS-Ⅱscores in the death group were significantly higher than those in the survival group(P<0.05),while platelet count and LCR at all moments were significantly lower than those in the survival group(P<0.05).The LCR of the death group continued to decrease with time.The trend of changes in the survival group were opposite,and the differences in the two groups between each two moments were statistically significant(P<0.05).The SAPS-Ⅱscores and LCR at all moments were risk factors for patient death(P<0.05).The SAPS-Ⅱscore and LCR at all moments had predictive value for patient death,and the area under ROC curve of the combined prediction was 0.921(95%CI 0.825-1.000),which was higher than the individual prediction and LCR at each moment combined with SAPS II score prediction(P<0.05).Conclusion The SAPS-Ⅱscores and LCR at different moments are all related to death of sepsis patients,and the combined prediction of death by the above indicators is highly effective.