肾动脉阻力指数联合肺动脉高压对脓毒症患者死亡风险的预测价值

Renal resistive index combined with pulmonary hypertension in assessing mortality risk in sepsis patients

目的 探讨肾动脉阻力指数(RRI)联合肺动脉高压(PH)对脓毒症患者死亡风险的预测价值。方法 回顾性分析2021年5月至2022年10月首都医科大学附属北京朝阳医院急诊监护室收治的115例脓毒症患者的临床及超声资料。根据患者28 d转归,将患者分为死亡组和存活组,比较两组患者一般资料、实验室检查结果与床边超声参数,采用Logistic回归分析脓毒症死亡的独立影响因素。描记受试者工作特征(ROC)曲线以评价年龄、RRI、PH对脓毒症患者死亡的预测价值。结果 死亡组61例,存活组54例,两组患者的年龄、氧合指数、乳酸、B型钠尿肽、心肌肌钙蛋白、RRI、右心房横径、右心室基底部内径、PH差异有统计学意义(P均<0.05)。Logistic多因素回归分析显示年龄、RRI、PH是脓毒症患者死亡的独立影响因素(OR=1.087、1.091、3.261,P<0.05)。年龄、RRI、PH的ROC曲线下面积分别为0.798、0.729、0.711,三者联合对脓毒症患者死亡风险预测曲线下面积为0.856,敏感性为83.6%,特异性为81.5%。结论 患者年龄(≥74岁)、RRI(≥0.73)、肺动脉高压是脓毒症死亡的重要风险因素,RRI联合PH可用于早期预警,预测老年脓毒症患者的死亡风险。

Objective To investigate the applicability of the renal resistive index(RRI)combined with pulmonary hypertension(PH)in predicting the mortality risk of patients with sepsis.Methods The clinical and ultrasonographic data of 115 sepsis patients was retrospectively analyzed who were admitted to the emergency ICU of Beijing Chaoyang Hospital between May 2021 and October 2022.These patients were categorized into the death and survival group based on their 28-day outcomes.The basic information,laboratory tests and bedside ultrasound parameters were compared between the two groups.Logistic regression analysis was used to identify independent factors associated with mortality in sepsis.Receiver operating characteristic(ROC)curves were used to assess the role of age,RRI,and PH in predicting sepsis mortality.Results Among these patients,61 were in the death group and 54 in the survival group.There were statistically significant differences between the two groups in terms of age,oxygenation indexes,lactate levels,B-type natriuretic peptide(BNP),cardiac troponin,RRI,right atrial transverse diameters,right ventricular basal diameters and PH(P<0.05).Multivariate logistic analysis showed that age,RRI,and PH were independent factors for mortality in sepsis patients(OR=1.087,1.091,3.261,P<0.05).The areas under the ROC curve for age,renal resistive indexes,and pulmonary hypertension were 0.798,0.729,and 0.711,respectively.The area for combined prediction under the curve for mortality risk in sepsis patients was 0.856,with a sensitivity of 83.6%and a specificity of 81.5%.Conclusion Age≥74 years,RRI≥0.73,and pulmonary hypertension are significant risk factors for mortality in sepsis.RRI combined with PH can be used for early warning to predict the mortality risk in elderly sepsis patients.