血清GDF-15、FGF-21水平对脓毒症患者病情评估及预后预测的临床价值

Clinical value of serum GDF-15 and FGF-21 levels in the evaluation and prognosis of patients with sepsis

目的探讨血清生长分化因子15(GDF-15)、成纤维化生长因子21(FGF-21)水平对脓毒症患者病情评估及其对预后的预测价值。方法回顾性将2020年1月至2023年6月承德医学院附属医院ICU收治的脓毒症患者102例作为研究对象。按Sepsis-3脓毒症诊断标准,按病情不同将患者分为脓毒症组(n=46)与脓毒症休克组(n=56);并按28 d预后不同将患者分为存活组(n=75)与死亡组(n=27)。收集患者常规临床资料,包括性别、年龄、白细胞(WBC)计数、D-二聚体、淋巴细胞(LY)计数、入院24 h的急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分。比较不同组别临床资料及血清GDF-15、FGF-21水平差异,分析患者GDF-15、FGF-21与APACHEⅡ评分的关系,并使用受试者操作特征(ROC)曲线评价GDF-15、FGF-21对患者28 d死亡的预测价值。结果脓毒症组与脓毒症休克组的性别构成比、年龄、LY等比较,差异均无统计学意义(P>0.05);脓毒性休克组WBC、D-二聚体、APACHEⅡ评分、GDF-15、FGF-21水平均高于脓毒症组,且28 d病死率高于脓毒症组,差异均有统计学意义(P<0.05)。死亡组与存活组的性别构成比、年龄、LY比较,差异均无统计学意义(P>0.05);死亡组WBC、D-二聚体、APACHEⅡ评分、血清GDF-15、FGF-21水平均高于存活组,差异均有统计学意义(P<0.05)。经Pearson相关分析得出,脓毒症患者血清GDF-15、FGF-21水平与APACHEⅡ评分均呈正相关(r=0.378、0.394,P<0.001)。Logistic回归分析得出,血清GDF-15(OR=1.169,95%CI:1.041~1.312)、FGF-21水平(OR=1.406,95%CI:1.129~1.752)和APACHEⅡ评分(OR=1.346,95%CI:1.095~1.653)均是脓毒症患者28 d死亡的危险因素(P<0.05)。ROC曲线分析得出,血清GDF-15、FGF-21预测脓毒症患者28 d死亡的曲线下面积(AUC)分别为0.888、0.820,与APACHEⅡ评分(AUC为0.867)相比差异均无统计学意义(P>0.05)。结论血清GDF-15、FGF-21水平增高与脓毒症患者病情较重相关,且对患者预后有一定预测能力。

Objective To investigate the clinical value of serum levels of growth differentiation factor 15(GDF-15),fibroblast growth factor 21(FGF-21)in the and the evaluation and prognosis of patients with sepsis.Methods A retrospective study was conducted on 102 patients with sepsis admitted to the ICU of the Affiliated Hospital of Chengde Medical College from January 2020 to June 2023.According to the criteria of Sepsis-3,the patients were divided into the sepsis group(n=46)and the septic shock group(n=56)according to the different cllness.The patients were divided into the survival group(n=75)and the death group(n=27)according to the 28-day prognosis.The routine clinical data of patients were collected,including gender,age,white blood cell count(WBC),D-dimer,lymphocyte(LY)count,and acute physiology and chronic health status evaluationⅡ(APACHEⅡ)score at 24 h after admission.The clinical data,serum GDF-15 and FGF-21 levels in different groups were compared,and the relationship between GDF-15 and FGF-21 and APACHEⅡscore was analyzed.The predictive value of GDF-15 and FGF-21 for 28-day death was evaluate using receiver operating characteristic(ROC)curve.Results There was no significant difference in sex ratio,age and LY between sepsis group and septic shock group(P>0.05).The levels of WBC,D-dimer,APACHEⅡscore,GDF-15 and FGF-21 in septic shock group were higher than those in sepsis group,and the 28-day mortality was higher than that in sepsis group,the differences were statistically significant(P<0.05).There was no significant difference in sex ratio,age and LY between the death group and the survival group(P>0.05).The WBC,D-dimer,APACHEⅡscore,serum GDF-15 and FGF-21 levels in the death group were higher than those in the survival group,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that serum GDF-15 and FGF-21 levels were positively correlated with APACHEⅡscore in patients with sepsis(r=0.378,0.394;P<0.001).Logistic regression analysis showed that serum GDF-15 level(OR=1.169,95%CI:1.041-1.312),FGF-21 water(OR=1.406,95%CI:1.129-1.752)and APACHEⅡscore(OR=1.346,95%CI:1.095-1.653)were risk factors for 28-day death in patients with sepsis(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum GDF-15 and FGF-21 in predicting 28-day death in patients with sepsis were 0.888 and 0.820,respectively,and there was no significant difference compared with APACHEⅡscore(AUC=0.867)(P>0.05).Conclusion The increase of serum GDF-15 and FGF-21 levels is related to the severity of sepsis and has a certain predictive ability for the prognosis of patients.