APACHEⅡ评分联合PA、PCT、IL⁃6对创伤性休克伴感染患者的病情及预后评估价值

The value of APACHE II score combined with PA,PCT,and IL⁃6 in evaluating the condition and prognosis of patients with traumatic shock and infection

目的探究创伤性休克伴感染患者的病情与急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)、血清前白蛋白(PA)、降钙素原(PCT)、白介素-6(IL⁃6)的关系,及上述指标对疾病预后的预测价值。方法选取2021年8月-2023年8月太和县人民医院急诊医学科收治的120例创伤性休克患者为研究对象,其中合并感染作为观察组(n=80),未合并感染作为对照组(n=40)。观察组根据患者疾病情况分为轻度组(未合并多器官功能障碍,n=48)和重度组(合并多器官功能障碍,n=32),再根据28 d死亡情况分为预后良好组(出院病情显著改善,n=43)和预后不良组(死亡或在ICU住院时间>1月,n=37)。统计入院2 h观察组和对照组APACHEⅡ评分和血清PA、PCT、IL⁃6水平,统计治疗7 d观察组亚组APACHEⅡ评分和血清PA、PCT、IL⁃6水平,使用受试者工作特征(ROC)曲线分析联合检测对创伤性休克伴感染严重程度评估及预后预测价值。结果入院2 h,观察组APACHEⅡ评分、血清PCT、IL⁃6水平高于对照组,血清PA水平低于对照组,差异均有统计学意义(t=2.033、2.315、2.467、2.303,P均<0.05);轻度组APACHEⅡ评分、血清PCT、IL⁃6水平均低于重度组,血清PA高于重度组,差异均有统计学意义(t=4.073、7.002、5.987、4.774,P均<0.05)。治疗7 d后,预后良好组APACHEⅡ评分、血清PCT、IL⁃6水平均低于预后不良组,PA水平高于预后不良组,差异均有统计学意义(t=2.382、3.123、2.857、4.195,P均<0.05)。ROC曲线分析结果显示,入院2 h患者APACHEⅡ评分、血清PA、PCT、IL⁃6水平及联合检测对创伤性休克伴感染严重程度评估概率曲线下面积(AUC)依次为0.762(95%CI:0.654~0.850)、0.811(95%CI:0.707~0.890)、0.799(95%CI:0.694~0.880)、0.839(95%CI:0.739~0.911)、0.943(95%CI:0.868~0.983),且单一指标AUC均低于联合预测(Z=3.311、3.009、2.567、2.737,P均<0.05)。ROC曲线分析结果显示,治疗7 d患者APACHEⅡ评分、血清PA、PCT、IL⁃6水平及联合检测对创伤性休克伴感染预后预测概率AUC依次为0.621(95%CI:0.506~0.727)、0.656(95%CI:0.541~0.758)、0.670(95%CI:0.556~0.771)、0.664(95%CI:0.550~0.766)、0.804(95%CI:0.700~0.884),且单一指标AUC均低于联合预测(Z=3.219、3.053、2.957、2.955,P均<0.05)。结论APACHEⅡ评分联合PA、PCT、IL⁃6对创伤性休克伴感染患者病情严重程度及预后评估具有一定参考价值。

Objective To explore the relationship between the condition of patients with traumatic shock accompanied by infection and the acute physiology and chronic health status scoring systemⅡ(APACHEⅡ),serum prealbumin(PA),procalcitonin(PCT),and interleukin⁃6(IL⁃6),and analyze the predictive value of the above indicators for disease prognosis.Methods A total of 120 cases of traumatic shock admitted to the Emergency Medicine Department of Taihe county People's Hospital from August 2021 to August 2023 were selected as the study subjects,with co⁃infection as the observation group(n=80)and no co⁃infection as the control group(n=40).Patients in the observation group were divided into mild group(without multiple organ dysfunction,n=48)and severe group(with multiple organ dysfunction,n=32)based on their disease condition.They were further divided into a good prognosis group(significantly improved discharge condition,n=43)and a poor prognosis group(died or hospitalized in the ICU for more than 1 month,n=37)based on 28 days of death.APACHEⅡscores and serum levels of PA,PCT,and IL⁃6 were determined in the observation group and control group after 2 hours of admission.APACHEⅡscores and serum levels of PA,PCT,and IL⁃6 were determined in the subgroups of the observation group after 7 days of treatment.Receiver operating characteristic(ROC)curve analysis was used to evaluate the severity of traumatic shock with infection and predict its prognosis.Results After 2 h of admission,APACHEⅡscore,serum PCT and IL⁃6 levels in the observation group were higher than those in the control group,and serum PA level was lower than that of the control group,the differences were statistically significant(t=2.033,2.315,2.467,2.303;all P<0.05);APACHEⅡscore,serum PCT and IL⁃6 levels were lower than those in the severe group,and serum PA was higher than that of the severe group,the differences were statistically significant(t=4.073,7.002,5.987,4.774;all P<0.05).After 7 d of treatment,the APACHEⅡscore,serum PCT,and IL⁃6 levels in the good prognosis group were lower than those in the poor prognosis group,and the PA level was higher than that of the poor prognosis group,the differences were statistically significant(t=2.382,3.123,2.857,4.195;all P<0.05).The ROC curve analysis results showed that the AUC values of APACHEⅡscore,serum PA,PCT,IL⁃6 levels,and their combination for assessing the severity of traumatic shock with infection in patients admitted for 2 hours were 0.762(95%CI:0.654-0.850),0.811(95%CI:0.707-0.890),0.799(95%CI:0.694-0.880),0.839(95%CI:0.739-0.911),and 0.943(95%CI:0.868-0.983),respectively,And the AUC values of a single factor were all lower than the value of combined factors(Z=3.311,3.009,2.567,2.737;all P<0.05).The ROC curve analysis results showed that the AUC values of APACHEⅡscore,serum PA,PCT,IL⁃6 levels,and their combination for predicting the prognosis of traumatic shock with infection in patients after 7 days of treatment were 0.621(95%CI:0.506-0.727),0.656(95%CI:0.541-0.758),0.670(95%CI:0.556-0.771),0.664(95%CI:0.550-0.766),and 0.804(95%CI:0.700-0.884),respectively.And the AUC values of single factor were all lower than that of the combined factors(Z=3.219,3.053,2.957,2.955;all P<0.05).Conclusion The combination of APACHE II score,PA,PCT,and IL⁃6 had certain reference value for evaluating the severity and prognosis of patients with traumatic shock and infection.