应激性血糖升高比值联合A2DS2评分在卒中相关性肺炎病情及预后评估中的应用
Application of stress hyperglycemia ratio combined with A2DS2 score in the evaluation of disease condition and prognosis of stroke-as-sociated pneumonia
徐敏 1王英钜 1柏晓林 1黄立刚1
作者信息
- 1. 上海市第六人民医院急诊科 上海 200233
- 折叠
摘要
目的 探讨应激性血糖升高比值(SHR)联合A2DS2(年龄、心房纤颤、吞咽困难、性别、卒中严重度)评分在卒中相关性肺炎(SAP)病情及预后评估中的应用价值.方法 回顾性分析于2022年10月至2023年10月上海市第六人民医院收治的118例SAP患者的临床资料,依据美国国立卫生研究院卒中量表(NIHSS)评价病情结果分为轻度组[NIHSS评分≤5分,n=36]、中度组(NIHSS评分5～15分,n=52)、重度组(NIHSS评分＞15分,n=30).依据3个月临床结局分为死亡组(n=39)和存活组(n=79).分别比较不同病情严重程度组、不同临床结局组基线资料、SHR、A2DS2评分;采用Spearman相关性检验分别分析病情严重程度、临床结局与SHR和A2DS2评分的关系;采用受试者操作特征(ROC)曲线下面积(AUC)检验SHR联合A2DS2评分预测SAP患者病情严重程度和临床结局的效能.结果 轻、中、重度组基线资料比较,差异均无统计学意义(P＞0.05).存活组与死亡组基线资料比较,差异均无统计学意义(P＞0.05).重度组 SHR、A2DS2 评分分别为 1.55±0.31、(6.08±2.01)分,均高于轻度组[1.03±0.25、(2.44±0.73)分]、中度组[1.32±0.27、(4.45±1.12)分],差异均有统计学意义(P＜0.05).死亡组SAP患者SHR、A2DS2评分分别为1.68±0.50、(6.32±2.13)分,均高于存活组[1.37±0.32、(4.72±1.41)分],差异均有统计学意义(P＜0.05).Spearman相关性检验分析结果显示,SHR和A2DS2评分与SAP患者病情严重程度呈正相关(r=0.457、0.486,P＜0.05),且SHR和A2DS2评分与SAP患者临床不良结局呈正相关(r=0.403、0.437,P＜0.05);根据ROC曲线下AUC预测价值,SHR联合A2DS2评分联合预测SAP患者病情严重程度的AUC为0.933(95％CI:0.876～0.991)(P＜0.05),且SHR联合A2DS2评分联合预测SAP患者临床结局的AUC为0.839(95％CI:0.756～0.922),具有较好预测价值(P＜0.05).结论 SHR、A2DS2评分与SAP患者病情进展及预后具有重要相关性,两者联合评估具备较高的预测SAP患者病情及预后的效能,可作为指导SAP治疗的有效指标.
Abstract
Objective To investigate the application value of stress hyperglycemia ratio(SHR)combined with A2DS2(age,atrial fibril-lation,dysphagia,gender,stroke severity)score on the evaluation of disease condition and prognosis of stroke-associated pneumonia(SAP).Methods The clinical data of 118 patients with SAP in the hospital from October 2022 to October 2023 were retrospectively analyzed.According to the results of National Institutes of Health stroke scale(NIHSS),the patients were divided into the mild group[NIHSS score≤5 points,n=36],the moderate group(NIHSS score of 5-15 points,n=52)and the severe group(NIHSS score＞15 points,n=30).By means of the three-month clinical outcomes,the patients were classified into the death group(n=39)and the survival group(n=79).The baseline data,SHR and A2DS2 score were compared among different severity groups and different clinical outcome groups.Spearman correlation test was used to ana-lyze the relationship between disease severity,clinical outcomes and SHR and A2DS2 score.The area under the receiver operating characteristic(ROC)curve(AUC)was used to test the efficiency of SHR combined with A2DS2 score on predicting the disease severity and clinical outcomes of SAP patients.Results There were no statistically significant differences in baseline data among the mild,moderate and severe groups(P＞0.05).There were no statistically significant differences in baseline data between the survival and death groups(P＞0.05).The scores of SHR and A2DS2 in the severe group were 1.55±0.31 and(6.08±2.01)points,respectively,which were higher than those in the mild group[1.03±0.25,(2.44±0.73)points]and the moderate group[1.32±0.27,(4.45±1.12)points],and the differences were statistically signifi-cant(P＜0.05).The SHR and A2 DS2 scores of SAP patients in the death group were 1.68±0.50 and(6.32±2.13)points,respectively,which were higher than those in the survival group[1.37±0.32 and(4.72±1.41)points],and the differences were statistically significant(P＜0.05).Spearman correlation test showed that SHR and A2DS2 score were positively correlated with the disease severity of SAP patients(r=0.457,0.486;P＜0.05),and SHR and A2DS2 score were positively correlated with clinical adverse outcomes of SAP patients(r=0.403,0.437;P＜0.05).According to the predictive value of AUC under the ROC curve,the AUC of SHR combined with A2DS2 score in predicting the disease severity of SAP patients was 0.933(95％CI:0.876-0.991)(P＜0.05),and the AUC of SHR combined with A2DS2 score in predicting clinical outcome of SAP patients was 0.839(95％CI:0.756-0.922),it had good predictive value(P＜0.05).Conclusion SHR and A2DS2 score are significantly correlated with the disease progression and prognosis of SAP patients.The combined evaluation of the two indicators has high efficiency on predicting the disease condition and prognosis of SAP patients,and can be used as an effective indicator to guide the treatment of SAP.
关键词
应激性血糖升高比值/A2DS2评分/卒中相关性肺炎/病情/预后Key words
Stress hyperglycemia ratio/A2DS2 score/Stroke-associated pneumonia/Disease condition/Prognosis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据