毛细血管渗漏指数联合MPV/PLT对腹腔脓毒症患者并发ARDS的预测价值

Prediction Value of Capillary Leakage Index Combined with MPV/PLT for ARDS in Patients with Abdominal Sepsis

目的探讨毛细血管渗漏指数(capillary leakage index,CLI)联合血小板平均体积与血小板计数比值(mean platelet volume to platelet count ratio,MPV/PLT)对腹腔脓毒症患者并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的预测价值。方法回顾性选取2016年7月~2022年5月徐州医科大学附属医院收治的腹腔脓毒症患者,根据是否合并ARDS将其分为ARDS组和非ARDS组。比较两组患者的临床资料。腹腔脓毒症患者发生ARDS的危险因素采用多因素Logistic回归分析。采用受试者工作特征(receiver operator characteristic,ROC)曲线评估CLI联合MPV/PLT对腹腔脓毒症患者ARDS发生的预测效能。结果共入组250例腹腔脓毒症患者,其中ARDS组113例,非ARDS组137例。多因素Logistic回归分析结果显示,序贯器官衰竭评估(Sequential Organ Failure Assessment,SOFA)评分、急性生理与慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)、CLI及MPV/PLT为预测腹腔脓毒症患者发生ARDS的独立危险因素。ROC曲线分析结果显示,联合指标(CLI联合MPV/PLT)的ROC曲线下面积(area under the curve,AUC)最大,为0.810,其次是APACHEⅡ评分,AUC为0.781,MPV/PLT、SOFA评分、CLI的AUC分别为0.770、0.749、0.704。当联合指标(CLI联合MPV/PLT)取最佳截断值0.3时,特异性为89.4%,敏感度为61.3%,优于单一指标对腹腔脓毒症患者发生ARDS的诊断预测价值。结论CLI及MPV/PLT可很好地预测腹腔脓毒症患者发生ARDS,当两者联合时,预测价值更高。

Objective To investigate the predictive value of capillary leakage index(CLI)combined with mean platelet volume to platelet count ratio(MPV/PLT)for acute respiratory distress syndrome(ARDS)in patients with abdominal sepsis.Methods Patients with abdominal sepsis admitted to the Affiliated Hospital of Xuzhou Medical University from July 2016 to May 2022 were retrospectively selected,and divided into ARDS group and non-ARDS group according to whether they were complicated with ARDS.The clinical data of the two groups were compared.The risk factors of ARDS in patients with abdominal sepsis were analyzed by multivariate Logistic regression.Receiver operator characteristic(ROC)curve was used to evaluate the predictive efficacy of CLI combined with MPV/PLT for ARDS occurrence in patients with abdominal sepsis.Results A total of 250 patients with abdominal sepsis were enrolled,including 113 patients in the ARDS group and 137 patients in the non-ARDS group.Multivariate Logistic regression analysis showed that Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,CLI and MPV/PLT were independent risk factors for predicting ARDS in abdominal sepsis.ROC curve analysis results showed that the area under the curve(AUC)of the combined index(CLI and MPV/PLT)was the largest,which was 0.810,followed by the APACHEⅡscore,which was 0.781.The AUC of MPV/PLT,SOFA score and CLI were 0.770,0.749 and 0.704,respectively.When the optimal cut-off value was 0.3,the specificity was 89.4%and the sensitivity was 61.3%,which was superior to the value of single index in the diagnosis and prediction of ARDS in patients with abdominal sepsis.Conclusion CLI and MPV/PLT can well predict ARDS in patients with abdominal sepsis,and when they are combined,the prediction value is higher.