目的建立脓毒症患者发生脓毒症休克的临床评分预测模型,从而早期识别和积极治疗脓毒症休克的高危患者。方法回顾性分析东莞市人民医院2018年1月1日至2021年12月31日以脓毒症入院的部分脓毒症患者82例,根据患者是否进展为脓毒症休克将其...目的建立脓毒症患者发生脓毒症休克的临床评分预测模型,从而早期识别和积极治疗脓毒症休克的高危患者。方法回顾性分析东莞市人民医院2018年1月1日至2021年12月31日以脓毒症入院的部分脓毒症患者82例,根据患者是否进展为脓毒症休克将其分为脓毒症组及脓毒症休克组。对患者的一般临床资料进行单因素分析,组间有统计学意义的连续变量指标应用受试者操作特征曲线寻找最佳截断值并分析其诊断价值;根据截断值对连续变量进行二分类资料转换,运用多因素二分类Logistic回归分析进一步筛选对脓毒症休克有预测价值的指标,根据各变量的β回归系数设立相应分值建立脓毒症休克预测模型。最后将2022年1月1日至2023年12月31日期间以脓毒症入院的64例患者对模型进行验证。结果单因素分析显示年龄、性别在两组间无统计学意义,其余观察指标均有统计学意义。将降钙素原(procalcitonin,PCT)≥12μg/L、C反应蛋白(C-reactive protein,CRP)≥181mg/L、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)≥17三项指标纳入多因素Logistic回归模型。预测模型方程:Y=2.471×PCT+1.76×CRP+1.009×NLR,截断值为2.62,即Y≥2.62时预示脓毒症进展为脓毒症休克可能性大,模型敏感度、特异度、准确度分别为89.5%、63.6%、85.9%。验证队列的验证结果为:敏感度88.2%、特异度83.3%、准确度85.9%。结论本研究建立的脓毒症休克临床评分预测模型简单易行,对于早期识别脓毒症患者是否进展为脓毒症休克有一定的价值,为临床及时救治脓毒症休克的高危患者提供理论依据。展开更多
Objectives： Trauma is among the leading causes of death. Medical management of blunt abdominal trauma （BAT） relies on judging patients for whom laparotomy is mandatory. This study aimed to determine BAT patients＇ ...Objectives： Trauma is among the leading causes of death. Medical management of blunt abdominal trauma （BAT） relies on judging patients for whom laparotomy is mandatory. This study aimed to determine BAT patients＇ signs, as well as paraclinical data, and to clarify the accuracy, sensitivity, specificity, positive and negative predictive value of clinical abdominal scoring system （CASS）, a new scoring system based on clinical signs, in predicting whether a BAT patient needs laparotomy or not. Methods： Totally 400 patients suspected of BAT that arrived at the emergency department of two university hospitals in Tehran from March 20, 2007 to March 19, 2009 were included in this study. They were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale （GCS）, pulse rate, time of presentation after trauma, abdomial clinical findings, respiratory rate, temperature, hemoglobin （Hb） concentration, focused abdominal sonography in trauma （FAST） and CASS. Results： Our measurements showed that CASS had an accuracy of 94%, sensitivity of 100%, specificity of 88%, positive predictive value of 90% and negative predictive value of 100% in determining the necessity of laparotomy in BAT patients. Moreover, in our analysis, systolic blood pressure, GCS, pulse rate, Hb concentration, time of presentation after trauma, abdominal clinical findings and FAST were also shown to be helpful in confirming the need for laparotomy （P〈0.05）. Conclusion： CASS is a promising scoring system in rapid detection of the need for laparotomy as well as in minimizing auxiliary expense for further evaluation in BAT patients, thus to promote the cost-benefit ratio and accuracy of diagnosis.展开更多
文摘目的建立脓毒症患者发生脓毒症休克的临床评分预测模型,从而早期识别和积极治疗脓毒症休克的高危患者。方法回顾性分析东莞市人民医院2018年1月1日至2021年12月31日以脓毒症入院的部分脓毒症患者82例,根据患者是否进展为脓毒症休克将其分为脓毒症组及脓毒症休克组。对患者的一般临床资料进行单因素分析,组间有统计学意义的连续变量指标应用受试者操作特征曲线寻找最佳截断值并分析其诊断价值;根据截断值对连续变量进行二分类资料转换,运用多因素二分类Logistic回归分析进一步筛选对脓毒症休克有预测价值的指标,根据各变量的β回归系数设立相应分值建立脓毒症休克预测模型。最后将2022年1月1日至2023年12月31日期间以脓毒症入院的64例患者对模型进行验证。结果单因素分析显示年龄、性别在两组间无统计学意义,其余观察指标均有统计学意义。将降钙素原(procalcitonin,PCT)≥12μg/L、C反应蛋白(C-reactive protein,CRP)≥181mg/L、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)≥17三项指标纳入多因素Logistic回归模型。预测模型方程:Y=2.471×PCT+1.76×CRP+1.009×NLR,截断值为2.62,即Y≥2.62时预示脓毒症进展为脓毒症休克可能性大,模型敏感度、特异度、准确度分别为89.5%、63.6%、85.9%。验证队列的验证结果为:敏感度88.2%、特异度83.3%、准确度85.9%。结论本研究建立的脓毒症休克临床评分预测模型简单易行,对于早期识别脓毒症患者是否进展为脓毒症休克有一定的价值,为临床及时救治脓毒症休克的高危患者提供理论依据。
文摘Objectives： Trauma is among the leading causes of death. Medical management of blunt abdominal trauma （BAT） relies on judging patients for whom laparotomy is mandatory. This study aimed to determine BAT patients＇ signs, as well as paraclinical data, and to clarify the accuracy, sensitivity, specificity, positive and negative predictive value of clinical abdominal scoring system （CASS）, a new scoring system based on clinical signs, in predicting whether a BAT patient needs laparotomy or not. Methods： Totally 400 patients suspected of BAT that arrived at the emergency department of two university hospitals in Tehran from March 20, 2007 to March 19, 2009 were included in this study. They were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale （GCS）, pulse rate, time of presentation after trauma, abdomial clinical findings, respiratory rate, temperature, hemoglobin （Hb） concentration, focused abdominal sonography in trauma （FAST） and CASS. Results： Our measurements showed that CASS had an accuracy of 94%, sensitivity of 100%, specificity of 88%, positive predictive value of 90% and negative predictive value of 100% in determining the necessity of laparotomy in BAT patients. Moreover, in our analysis, systolic blood pressure, GCS, pulse rate, Hb concentration, time of presentation after trauma, abdominal clinical findings and FAST were also shown to be helpful in confirming the need for laparotomy （P〈0.05）. Conclusion： CASS is a promising scoring system in rapid detection of the need for laparotomy as well as in minimizing auxiliary expense for further evaluation in BAT patients, thus to promote the cost-benefit ratio and accuracy of diagnosis.
