D-二聚体、25-羟维生素D、乳酸、降钙素原联合检测对脓毒血症患者预后的评估价值

Prognostic value of combined detection of D-dimer,25-hydroxyvitamin D,lactic acid and procalcitonin in patients with sepsis

目的探讨D-二聚体(D-D)、25-羟维生素D[25(OH)D]、乳酸(LA)、降钙素原(PCT)联合检测对脓毒血症患者预后的评估价值。方法选取2018年1月至2021年3月在邢台市第三医院治疗的116例脓毒血症患者作为研究对象。根据急性生理与慢性健康状况系统(APACHEⅡ)评分将患者分为A、B、C组,比较各组患者D-D、25(OH)D、LA及PCT水平。根据患者28 d生存情况将患者分为生存组与死亡组,比较两组D-D、25(OH)D、LA及PCT水平。采用Pearson相关分析脓毒症患者D-D、25(OH)D、LA及PCT水平与APACHEⅡ评分的相关性。绘制受试者工作特征(ROC)曲线分析D-D、25(OH)D、LA、PCT单独及4项指标联合检测对脓毒症患者死亡的预测价值。结果A组27例患者,B组59例患者,C组30例患者,3组D-D、PCT、LA水平比较,均为A组<B组<C组,差异均有统计学意义(P<0.05)。3组25(OH)D水平比较,A组>B组>C组,差异均有统计学意义(P<0.05)。生存组纳入73例患者,死亡组纳入43例患者。死亡组D-D、LA、PCT水平与APACHEⅡ评分均高于生存组,25(OH)D水平低于生存组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,D-D、LA、PCT水平与APACHEⅡ评分均呈正相关(r=0.694、0.715、0.668,P<0.05),25(OH)D水平与APACHEⅡ评分呈负相关(r=-0.603,P<0.05)。ROC曲线分析结果显示,D-D、25(OH)D、LA、PCT对脓毒症患者死亡预测的曲线下面积分别为0.901、0.891、0.803、0.759,均低于4项指标联合检测的0.952(Z=3.715、3.692、4.039、5.156,P<0.05)。结论D-D、25(OH)D、LA、PCT均对脓毒血症患者28d死亡具有较高的预测价值,且联合检测可提高诊断效能,可通过检测上述指标预测脓毒血症患者预后并指导治疗。

Objective To investigate the value of combined detection of D-dimer(D-D),25-hydroxyvitamin D[25(OH)D],lactic acid(LA)and procalcitonin(PCT)in evaluating the prognosis of patients with sepsis.Methods A total of 116 patients with sepsis treated in the Third Hospital of Xingtai from January 2018 to March 2021 were selected as the research objects.According to the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,the patients were divided into group A,B and C,and the levels of D-D,25(OH)D,LA and PCT in each group were compared.According to the 28-day survival,the patients were divided into survival group and death group,and the levels of D-D,25(OH)D,LA and PCT were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between D-D,25(OH)D,LA,PCT levels and APACHEⅡscore in patients with sepsis.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of D-D,25(OH)D,LA,PCT alone and combined detection of the four indicators for the death of patients with sepsis.Results There were 27 patients in group A,59 patients in group B and 30 patients in group C.The levels of D-D,PCT and LA in the three groups were compared,and all of them were group A<group B<group C,and the differences were statistically significant(P<0.05).The 25(OH)D level of the three groups was group A>group B>group C,and the differences were statistically significant(P<0.05).There were 73 patients in the survival group and 43 patients in the death group.The levels of D-D,LA,PCT and APACHEⅡscore in the death group were higher than those in the survival group,and the level of 25(OH)D was lower than that in the survival group,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the levels of D-D,LA and PCT were positively correlated with APACHEⅡscore(r=0.694,0.715,0.668,P<0.05),and the level of 25(OH)D was negatively correlated with APACHEⅡscore(r=-0.603,P<0.05).The results of ROC curve analysis showed that the area under the curve of D-D,25(OH)D,LA,and PCT in predicting the death of patients with sepsis was 0.901,0.891,0.803,and 0.759,respectively,which were lower than 0.952 of the combined detection of the four indicators(Z=3.715,3.692,4.039,5.156,P<0.05).Conclusion D-D,25(OH)D,LA and PCT all have high predictive value for 28 d mortality in patients with sepsis,and combined detection can improve the diagnostic efficiency.The above indicators can be used to predict the prognosis of patients with sepsis and guide treatment.