Delta样配体1水平对脓毒症患者病情危险分层及预后的评估价值

The evaluation value of Delta-like ligand 1 levels in risk stratification and prognosis of sepsis patients

目的探讨血浆Delta样配体1(Delta-like ligand 1,DLL1)水平在判断脓毒症患者疾病严重程度及预后价值中的作用。方法收集86例脓毒症患者的临床资料,根据入院后患者的病情严重程度分为脓毒症组40例和脓毒性休克组46例,根据28 d后患者的生存状况分为存活组53例和死亡组33例。比较各组基线资料、生化指标、序贯器官衰竭(sequential organ failure assessment,SOFA)评分、急性生理学及慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ)评分及血浆DLL1水平差异,分析DLL1与SOFA评分、APACHEⅡ评分、C反应蛋白、降钙素原、白介素6(IL-6)的相关性,ROC曲线分析其对疾病严重程度及预后的价值。结果与脓毒症患者相比,脓毒性休克组患者血浆DLL1水平明显升高,差异有统计学意义(t=9.819,P<0.001);死亡患者血浆DLL1水平较生存患者升高,差异有统计学意义(t=1.976,P=0.04);Pearson相关性分析显示,血浆DLL1水平与脓毒症患者SOFA评分、APACHEⅡ评分、IL-6呈显著性正相关(r^(2)=0.1301,P<0.001;r^(2)=0.0749,P=0.0107;r^(2)=0.0739,P=0.0370);多因素分析显示DLL1是判断脓毒症病情严重程度的独立危险因素(OR=1.369,95%CI:1.151~1.628),ROC曲线显示血浆DLL1水平判断脓毒症严重程度的AUC为0.928(95%CI:0.877~0.979),cut-off值为47.105 ng/mL,灵敏度为0.913,特异度为0.825;DLL1高水平组死亡率显著高于DLL1低水平组,差异有统计学意义(P=0.002)。结论DLL1在判断脓毒症病情严重程度及预后中有一定的评估价值。

Objective To explore the role of plasma Delta-like ligand 1(DLL1)levels in assessing the severity and prognostic value of sepsis in patients.Methods Clinical data of 86 patients with sepsis were collected and divided into sepsis group(n=40)and septic shock group(n=46)based on the severity of their condition after admission.According to the survival status of patients 28 days later,86 patients were divided them into a survival group(n=53)and a death group(n=33).Baseline data,biochemical index,sequential organ failure assessment(SOFA)score,acute physiology and chronic health score systemⅡ(APACHEⅡ)score,and plasma DLL1 levels were compared.The correlation between DLL1 and SOFA score,APACHEⅡscore,C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)were analyzed,The ROC curve was used to analyze the value of disease severity and prognosis.Results Compared with sepsis patients,the plasma DLL1 levels in the septic shock group were significantly increased(t=9.819,P<0.001),and the plasma DLL1 levels in deceased patients were higher than those in surviving patients(t=1.976,P=0.04).Pearson correlation analysis showed that plasma DLL1 levels were significantly positively correlated with SOFA score,APACHEⅡscore,and IL-6 in sepsis patients(r^(2)=0.1301,P<0.001;r^(2)=0.0749,P=0.0107;r^(2)=0.0739,P=0.0370),Multivariate analysis showed that DLL1 was an independent risk factor for judging the severity of sepsis,with an OR of 1.369(95%CI:1.151-1.628).The ROC curve showed that the AUC of plasma DLL1 level for judging the severity of sepsis was 0.928(95%CI:0.877-0.979),with a cut-off value of 47.105 ng/mL,sensitivity of 0.913,and specificity of 0.825.The mortality of the DLL1 high-level group was significantly higher than that of the DLL1 low-level group,and the difference was statistically significant(P=0.002).Conclusion DLL1 has evaluative value in assessing the severity and prognosis of sepsis.