APACHEⅡ评分、血乳酸浓度、D-二聚体与重症感染患者预后的相关性分析

Correlation between APACHEⅡscore,lactic acid concentration,D-dimer and prognosis in patients with severe infection

目的探讨急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分、血乳酸浓度、D-二聚体与重症感染患者预后的相关性。方法选取2021年1月至2022年12月安徽省第二人民医重症医学科收治的81例重症感染患者纳入观察组,根据28 d预后情况分为生存组49例和死亡组32例。观察死亡组、生存组临床特征及APACHEⅡ评分、血乳酸浓度、D-二聚体水平;Pearson相关性分析死亡组APACHEⅡ评分和血乳酸浓度、D-二聚体的关系;影响预后的危险因素采用多因素Logistic逐步回归分析;受试者工作曲线(ROC)分析APACHEⅡ评分、血乳酸浓度、D-二聚体对预后不良的预测价值。结果观察组APACHEⅡ评分、血乳酸浓度、D-二聚体水平高于对照组,差异有统计学意义(t=4.269,8.785,2.746,P<0.05);死亡组机械通气比例、SOFA评分、ICU住院时间和PCT水平高于生存组,差异有统计学意义(χ^(2)=4.847,4.940,t=8.256,12.474,P<0.05);死亡组APACHEⅡ评分、乳酸、D-二聚体水平高于生存组,差异有统计学意义(t=2.629,9.702,3.086,P<0.05);Pearson相关性,死亡组APACHEⅡ评分和血乳酸浓度、D-二聚体呈正相关(P<0.05);Logistic回归分析,机械通气、APACHE-II评分≥22.28分和血乳酸浓度≥3.58 mmol/L均为影响重症感染患者预后不良的独立危险因素(P<0.0.5);ROC分析,APACHEⅡ评分、血乳酸浓度、D-二聚体联合检测预测重症感染患者预后不良的AUC为0.921(P<0.05)。结论重症感染患者APACHEⅡ评分、血乳酸浓度、D-二聚体与其预后密切相关,其中APACHE-Ⅱ评分和血乳酸浓度均为影响重症感染患者预后的危险因素。

Objective To explore the correlation between score of acute physiology and chronic health evaluationⅡ(APACHEⅡ),lactic acid concentration,D-dimer and prognosis in patients with severe infection.Methods A total of 81 patients with severe infection admitted to Critical Care Medicine Department of the hospital were enrolled as the observation group between January 2021 and December 2022.According to 28 d prognosis,they were divided into the survival group(49 cases)and the death group(32 cases).The clinical characteristics,APACHEⅡscore,lactic acid concentration and D-dimer level were compared between the observation group and the control group,as well as between the survival group and the death group.The relationship between APACHEⅡscore and lactic acid concentration,D-dimer was analyzed by Pearson correlation analysis.The risk factors of prognosis were analyzed by multivariate logistic stepwise regression analysis.The predictive value of APACHEⅡscore,lactic acid concentration and D-dimer for poor prognosis was analyzed by the receiver operating characteristic(ROC)curves.Results The APACHEⅡscore,lactic acid concentration and D-dimer level in the observation group were higher than those in the control group(t=4.269,8.785,2.746,P<0.05).The proportion of mechanical ventilation,SOFA score,stay time in ICU and PCT level in the death group were higher than those in the survival group(χ^(2)=4.847,4.940,8.256,12.474,P<0.05),the APACHEⅡscore,lactic acid and D-dimer in the death group were higher than those in the survival group(t=2.629,9.702,3.086,P<0.05).Pearson correlation analysis showed that the APACHEⅡscore was positively correlated with the lactic acid concentration and D-dimer level(P<0.05).Logistic regression analysis showed that mechanical ventilation,APACHEⅡscore≥22.28 points and lactic acid concentration≥3.58 mmol/L were independent risk factors of poor prognosis(P<0.0.5).The ROC curves analysis showed that the area under the curve(AUC)of the APACHEⅡscore combined with the lactic acid concentration and D-dimer for predicting poor prognosis was 0.921(P<0.05).Conclusion The APACHE II score,lactic acid concentration and D-dimer are closely related to prognosis in patients with severe infection.Among them,the APACHEⅡscore and lactic acid concentration are risk factors affecting the prognosis in patients with severe infection.