目的:探讨脓毒症患者系统免疫炎症指数(systemic immune inflammatory index,SⅡ)、D-二聚体水平与序贯器官衰竭评分(sequential organ failure assessment,SOFA)的变化及其对预后的评估价值.方法:回顾性分析2021年7月到2023年7月在新疆医科大学第二附属医院住院的114名脓毒症患者,另选同一时期健康体检者43例作为对照组,脓毒症患者收住院后进行血液标本实验室检查,得出SOFA评分.所有脓毒症患者随访28 d,依据患者住院期间的临床结局分为生存组37例和死亡组77例.比较3组间SⅡ、D-二聚体水平与SOFA评分的差异;单因素和多因素Logistic回归分析脓毒症患者的基线资料,得出脓毒症患者死亡的独立影响因素,并且绘制森林图;Spearman相关性分析SⅡ、D-二聚体水平和SOFA评分与脓毒症患者预后的相关性;通过ROC曲线对SⅡ、D-二聚体水平、SOFA评分及三者联合检测进行评估,绘制生存率曲线;最后,基于R语言对模型采用Bootstrap法重抽样500次后,绘制校准曲线及临床决策曲线.结果:脓毒症死亡组患者SⅡ、D-二聚体水平、SOFA评分较生存组及对照组明显升高,差异均具有统计学意义.脓毒症患者的死亡率为68％.单因素Logistic回归的分析结果表明,SⅡ、D-二聚体水平、SOFA评分是脓毒症患者死亡的相关因素.多因素Logistic回归分析显示,高SⅡ、D-二聚体水平、SOFA评分是脓毒症病人死亡的独立危险因素.SⅡ、D-二聚体水平、SOFA评分与脓毒症患者死亡呈正相关,ROC曲线分析结果表明,SⅡ、D-二聚体水平、SOFA评分及三者联合检测预测脓毒症患者死亡的曲线下面积依次为0.822、0.888、0.874、0.967.SⅡ在最佳截断值2 063.5时,诊断敏感度为73.700％,特异度为75.000％;D-二聚体水平在最佳截断值3.8 mg/mL时,诊断敏感度为85.500％,特异度为80.600％;SOFA评分在最佳截断值9.500分时,诊断敏感度是75.000％,特异度是86.100％.三者联合检测的敏感度为93.400％,特异度为91.700％.结论:SⅡ、SOFA评分、D-二聚体水平升高是脓毒症患者死亡的独立危险因素,构建预测模型的拟合度及临床适用性较高,三者联合检测对脓毒症患者的预测价值更高.
Changes in systemic immune inflammatory index,D-dimer level and SOFA score in patients with sepsis and their prognostic value assessment
Objective:To investigate the changes in systemic immune inflammatory index(SⅡ),D-dimer level and SOFA score in patients with sepsis and their prognostic value assessment.Methods:Retrospectivly analyzed 114 patients with sepsis hospitalized in the Second Affiliated Hospital of Xinjiang Medical University during the period from July 2021 to July 2023.43 patients who underwent health checkups during the same period were selected as the control group.Laboratory tests such as coagulation series and blood specimens were performed after admission to the hospital to derive SOFA score.All sepsis patients were followed up for 28 d.Based on the clinical outcomes during hospitalization,the patients were divided into 37 cases in the survival group and 77 cases in the death group.The differences between SⅡ,D-dimer level and SOFA score in the three groups were compared.Univariate and multivariate Logistic regression were used to analyze the baseline data of sepsis patients,to derive the independent factors influencing the death of sepsis patients,and to draw forest plots;Spearman correlation analysis of SⅡ index,D-dimer level and SOFA score with prognosis of patients with sepsis;survival curves were plotted by ROC curves assessing SⅡ,D-dimer level,SOFA scores and the combination of all three.Finally,calibration curves and clinical decision curves were plotted based on the R after the model was re-sampled 500 times using the Bootstrap method.Results:Patients in the sepsis death group had significantly higher SⅡ,D-dimer,and SOFA score than those in the survival and control groups,and the differences were statistically significant.The case fatality rate of patients with sepsis was 68％.Analysis of one-way Logistic regression showed that SⅡ,D-dimer level,and SOFA score were correlates of death in sepsis patients.Multifactorial Logistic regression analysis showed that high SⅡ,high D-dimer level,and high SOFA score were independent risk factors for death in patients with sepsis.SⅡ,D-dimer level,and SOFA score were positively correlated with death in patients with sepsis.The results of the ROC curve analysis showed that the area under the curve of SⅡ,D-dimer level,SOFA score,and the combined test to predict death in patients with sepsis,were 0.822,0.888,0.874,0.967 respectively.The diagnostic sensitivity was 73.700％and specificity was 75.000％at the optimal cut-off value of 2 063.5 for SⅡ.The diagnostic sensitivity was 85.500％and specificity 80.600％at the optimal cut-off value of 3.8 mg/mL for D-dimer level.The diagnostic sensitivity was 75.500％and specificity was 86.100％at the cut-off value of 9.500 points for SOFA score.The sensitivity of the combined test was 93.400％and the specificity was 91.700％.Conclusion:Elevated levels of SⅡ,D-dimer and SOFA score are independent risk factors for death in sepsis patients,the constructed prediction model has high goodness of fit and clinical applicability,and the combination of the three tests has higher predictive value for sepsis patients.
systemic immune-inflammatory indexD-dimersequential organ failure assessmentsepsis
万方数据
维普
