首页|24 h乳酸清除率和序贯器官衰竭评分及简化急性生理评分Ⅱ对脓毒症预后的预测价值研究

24 h乳酸清除率和序贯器官衰竭评分及简化急性生理评分Ⅱ对脓毒症预后的预测价值研究

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目的 探究简化急性生理评分Ⅱ(simplified acute physiological score-Ⅱ,SAPS Ⅱ)、序贯器官衰竭评估(sequen-tial organ failure assessment,SOFA)评分及24 h乳酸清除率(24 h lactate clearance,LCR)对脓毒症患者预后的预测价值.方法 回顾性研究,选取2023年1月-2024年1月郑州大学第一附属医院外科ICU诊治的96例脓毒症患者,依据预后情况将患者分为生存组71例及死亡组25例.比较两组患者实验室指标[血钙、降钙素原(procalcito-nin,PCT)、乳酸脱氢酶(lactate dehydrogenase,LDH)]等水平,24 h LCR、SAPS Ⅱ评分及 SOFA 评分,logistic 分析 24 h LCR、SOFA评分及SAPS Ⅱ评分对患者预后独立危险因素,ROC曲线评估24 h LCR、SOFA评分及SAPS Ⅱ评分对患者预后的预测价值.结果 生存组血钙指标(2.03±0.21)mmol/L高于死亡组(1.65±0.12)mmol/L,PCT、LDH指标分别是(3.25±0.16)μg/L及(4.93±1.26)mmol/L,均低于死亡组,差异有统计学意义(P<0.05);生存组24 h LCR(30.21±6.73)%高于死亡组(22.16±5.92)%,SAPS Ⅱ评分及SOFA评分分别是(37.29±7.15)分和(5.86±1.47)分,均低于死亡组,差异有统计学意义(P<0.05);logistic分析数据表明,24 h LCR、SOFA评分及SAPS Ⅱ评分是患者预后独立危险因素,(P<0.05);ROC曲线分析结果表明:24 h LCR预测患者预后曲线下面积为0.753,灵敏度为74.2%、特异度为73.4%;SOFA评分预测患者预后曲线下面积为0.775,灵敏度为82.9%、特异度为74.8%;SAPS Ⅱ评分预测患者预后曲线下面积为0.772,灵敏度为85.6%、特异度为72.5%;三者联合预测患者预后曲线下面积为0.802,灵敏度为86.4%、特异度为81.9%.结论 SOFA及SAPS Ⅱ评分、24 h LCR联合血钙、PCT对患者预后有较高预测价值,可作为患者预后的预测指标.
Predictive value of 24 h lactate clearance and sequential organ failure score and simplified acute physiological score Ⅱ in sepsis
Objective To explore the predictive value of simplified acute physiological score-Ⅱ(SAPS Ⅱ),sequential or-gan failure assessment(SOFA)score,and 24 h lactate clearance(LCR)on the prognosis of patients with septic shock.Methods A retrospective study was conducted to select 96 patients with sepsis treated in the surgical ICU of the First Affil-iated Hospital of Zhengzhou University from January 2023 to January 2024.According to the prognosis,the patients were divided into a survival group(71 cases)and a death group(25 cases).Laboratory indexes[blood calcium,procalcitonin(PCT),lactate dehydrogenase(LDH)]levels,24 h LCR,SAPS Ⅱ scores and SOFA scores were compared between the two groups.The independent risk factors of 24 h LCR,SOFA score and SAPS Ⅱ score were analyzed by logistic analysis,and the predictive value of 24 h LCR,SOFA score and SAPS Ⅱ score on patient prognosis was evaluated by ROC curve.Results The blood calcium index(2.03±0.21)mmol/L in survival group was higher than that in death group(1.65±0.12)mmol/L,and the PCT and LDH indexes were(3.25±0.16)μg/L and(4.93±1.26)mmol/L,respectively,which were lower than those in death group(P<0.05).24 h LCR(30.21±6.73)% in survival group was higher than that in death group(22.16±5.92)%,SAPS Ⅱ score and SOFA score were(37.29±7.15)and(5.86±1.47)points,respectively,which were lower than those in death group(P<0.05).Logistic analysis data showed that 24 h LCR,SOFA score and SAPS Ⅱ score were independent risk factors for prognosis(P<0.05).ROC curve analysis results showed that 24 h LCR predicted the area under the prognosis curve was 0.753,the sensitivity was 74.2%,and the specificity was 73.4%.SOFA score predicted the area under the prognosis curve was 0.775,sensitivity was 82.9%,specificity was 74.8%.The area under the prognosis curve predicted by SAPS Ⅱ score was 0.772,the sensitivity was 85.6%,and the specificity was 72.5%.The area under the prognosis curve was 0.802,the sensitivity was 86.4%,and the specificity was 81.9%.Conclusion SOFA and SAPS Ⅱ scores,24-hour LCR combined with blood calcium,and PCT have high pre-dictive value for the prognosis of patients,and can be used as predictive indicators for patient prognosis.

24 h lactate clearanceSequential organ failure assessment scoreSimplified acute physiological score-ⅡscoreBlood calciumProcalcitoninSeptic shockPrognosis

徐大千、黄智、冯敏、杨宏富

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郑州大学第一附属医院重症医学科,郑州 450052

24 h乳酸清除率 序贯器官衰竭评估评分 简化急性生理评分Ⅱ 血钙 降钙素原 脓毒性休克 预后

河南省医学科技攻关计划联合共建项目

LHGJ20190213

2024

医药论坛杂志
中华预防医学会,河南省医学情报研究所

医药论坛杂志

影响因子:0.47
ISSN:1672-3422
年,卷(期):2024.45(18)