乳酸清除率与毛细血管再充盈时间对脓毒性休克患者的预后预测

Prognostic Prediction of Lactate Clearance Rate and Capillary Refilling Time in Pa⁃tients with Septic Shock

目的:分析乳酸清除率与毛细血管再充盈时间对脓毒性休克患者短期预后的预测价值。方法:本研究以2020年12月-2023年4月宁化县总医院收治的120名脓毒性休克患者为研究样本,根据其28天内的预后结果划分为生存组和病死组进行比较分析。比较两组患者性别、年龄、基础疾病、感染部位、各项实验室指标、24 h内APACHEⅡ、SOFA评分、24 h乳酸清除率与毛细血管再充盈时间;应用多因素Logistic回归分析方法,筛选出影响脓毒性休克患者预后的危险因素;绘制受试者工作特征曲线(ROC曲线)分析乳酸清除率与毛细血管再充盈时间对脓毒性休克患者28 d预后的预测价值。结果:单因素分析结果显示:病死组较生存组APACHEⅡ、SOFA评分更高(P<0.05),病死组24 h乳酸清除率显著低于生存组(P<0.05),病死组治疗后24 h毛细血管再充盈时间高于生存组(P<0.05)。多因素Logistic回归分析显示:APACHEⅡ评分、SOFA评分、治疗后24hCRT、动脉24hLCR是影响脓毒性休克患者短期预后的独立危险因素(P<0.05)。ROC曲线分析显示:24 h乳酸清除率与毛细血管再充盈时间对脓毒性休克患者预后有一定的预测作用[乳酸清除率:AUC=0.821,95%CI为0.740-0.903,当最佳截断值为5.984%时,其敏感度、特异度分别为0.750、0.827。毛细血管再充盈时间:AUC=0.863,95%CI为0.796-0.930,当最佳截断值为2.745s时,其敏感度、特异度分别为0.765、0.885];且联合预测具有较高的敏感度(0.882)和特异度(0.865),AUC(0.936)。结论:在脓毒性休克患者中,APACHE II评分、SOFA评分、治疗后24n内的毛细血管再充盈时间,以及动脉24h乳酸清除率,是影响其短期内死亡风险的独立危险因素;毛细血管再充盈时间、乳酸清除率联合预测脓毒性休克短期预后的准确性优于单个变量,诊断价值更高。

Objective:To analyze the predictive value of lactate clearance rate and capillary refilling time on the short-term prognosis of patients with septic shock.Methods:This study used 120 patients with septic shock admitted to Ninghua County General Hospital from December 2020 to April 2023 as the research sample,and divided them into sur-vival group and mortality group for comparative analysis based on their 28 day prognosis results.Compare the gender,age,underlying disease,site of infection,various laboratory indicators,APACHE II and SOFA scores within 24 hours,24-hour lactate clearance rate,and capillary refilling time between two groups of patients;Using multiple logistic regres-sion analysis methods,identify risk factors that affect the prognosis of patients with septic shock;Draw receiver operat-ing characteristic(ROC)curves to analyze the predictive value of lactate clearance rate and capillary refilling time on the 28 day prognosis of patients with septic shock.Results:Univariate analysis showed that the APACHE II and SOFA scores were higher in the mortality group than in the survival group(P<0.05),and the 24-hour lactate clearance rate in the mortality group was significantly lower than that in the survival group(P<0.05).The capillary refilling time after 24 hours of treatment in the mortality group was higher than that in the survival group(P<0.05).Multivariate logistic regres-sion analysis showed that APACHE II score,SOFA score,24-hour post-treatment CRT,and arterial 24-hour LCR were independent risk factors affecting the short-term prognosis of patients with septic shock(P<0.05)ROC curve analysis shows that 24-hour lactate clearance rate and capillary refilling time have a certain predictive effect on the prognosis of patients with septic shock.Lactate clearance rate:AUC=0.821,95%CI is 0.740-0.903,and when the optimal cutoff value is 5.984%,its sensitivity and specificity are 0.750 and 0.827,respectively.Capillary refilling time:AUC=0.863,95%CI is 0.796-0.930.When the optimal cutoff value is 2.745s,its sensitivity and specificity are 0.765 and 0.885,re-spectively;And the joint prediction has high sensitivity(0.882)and specificity(0.865),AUC(0.936).Conclusion:In patients with septic shock,APACHE II score,SOFA score,capillary refilling time within 24 hours after treatment,and arterial lactate clearance rate within 24 hours are independent risk factors affecting their short-term mortality risk;The combined prediction of capillary refilling time and lactate clearance rate for short-term prognosis of septic shock is more accurate than a single variable,and has higher diagnostic value.