RDW D-二聚体炎性因子及经胸肺超声评估脓毒症患者预后的价值

The Value of RDW D-dimer Inflammatory Factors and Transthoracic Pulmonary Ultrasound in Evaluating the Prognosis of Sepsis Patients

目的:探讨红细胞分布宽度(RDW)、D-二聚体(D-D)、炎性因子及经胸肺超声评估脓毒症患者预后的价值。方法:采用回顾性研究方法,选取2020年1月至2023年10月在我院治疗的脓毒症患者98例,其中单纯脓毒症患者51例,脓毒症休克患者47例;死亡患者26例,存活患者72例。比较有无休克、不同预后患者临床资料、RDW、D-D、炎性因子及经胸肺超声差异,并分析患者预后的影响因素。结果:脓毒症休克患者RDW、D-D、白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-(TNF-α)、胸肺超声融合B线>2个分区比例、急性生理学及慢性健康状况评分系统(APACHEⅡ)评分分别为16.68(14.12,19.55)%、3.22(2.15,7.78)mg/L、(410.03±102.21)pg/L、(32.21±11.15)mg/L、(503.74±98.87)ng/mL、70.21%和(18.84±1.15)分,高于单纯脓毒症患者(P<0.05);死亡患者年龄、脓毒症休克比例、RDW、D-D、IL-6、CRP、TNF-α、胸肺超声融合B线>2个分区比例、APACHEⅡ评分分别为(65.51±8.22)岁、76.92%、18.87(15.21,22.10)%、3.90(2.65,8.10)mg/L、(425.59±98.21)pg/L、(31.14±9.98)mg/L、(522.25±100.18)ng/mL、88.46%和(19.11±1.43)分,高于存活患者(P<0.05);Logistic回归分析显示:RDW、D-D、IL-6、CRP、TNF-α、胸肺超声融合B线>2个分区比例、APACHEⅡ评分是患者死亡的影响因素(P<0.05),Logistic模型预测脓毒症患者死亡的ROC曲线下面积为0.842(95%CI:0.757~0.927),灵敏性和特异性分别为76.00%和78.10%。结论:RDW、D-D、IL-6、CRP、TNF-α及胸肺超声融合B线与脓毒症患者是否发生休克、预后有关,且在预测患者预后方面有一定应用价值。

Objective:To explore the value of red blood cell distribution width(RDW),D-dimer(D-D),inflammatory factors,and transthoracic lung ultrasound in evaluating the prognosis of sepsis patients.Methods:A retrospective study was conducted on 98 sepsis patients treated in our hospital from January 2020 to October 2023,including 51 patients with simple sepsis and 47 patients with septic shock.There were 26 deceased patients and 72 surviving patients.Clinical data,RDW,D-D,inflammatory factors,and transthoracic lung ultrasound differences were compared among patients with and without shock,and with different prognoses.Factors influencing patient prognosis were analyzed.Results:Sepsis shock patients had RDW,D-D,interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-alpha(TNF-alpha),transthoracic lung ultrasound B-line fusion>2 zones ratio,and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores of 16.68(14.12,19.55)%,3.22(2.15,7.78)mg/L,(410.03±102.21)pg/L,(32.21±11.15)mg/L,(503.74±98.87)ng/mL,70.21%,and(18.84±1.15)points,respectively,which were higher than those of simple sepsis patients(P<0.05).The age,proportion of septic shock,RDW,D-D,IL-6,CRP,TNF-alpha,transthoracic lung ultrasound B-line fusion>2 zones ratio,and APACHEⅡscores of deceased patients were(65.51±8.22)years,76.92%,18.87(15.21,22.10)%,3.90(2.65,8.10)mg/L,(425.59±98.21)pg/L,(31.14±9.98)mg/L,(522.25±100.18)ng/ml,88.46%,and(19.11±1.43)points,respectively,which were higher than those of surviving patients(P<0.05).Logistic regression analysis showed that RDW,D-D,IL-6,CRP,TNF-alpha,transthoracic lung ultrasound B-line fusion>2 zones ratio,and APACHEⅡscores were influencing factors for patient mortality(P<0.05).The area under the ROC curve for predicting mortality in sepsis patients using the Logistic model was 0.842(95%CI:0.757-0.927),with sensitivity and specificity of 76.00%and 78.10%,respectively.Conclusion:RDW,D-D,IL-6,CRP,TNF-alpha,and transthoracic lung ultrasound B-line fusion are related to whether sepsis patients develop shock and their prognosis,and have certain application value in predicting patient prognosis.