摘要
目的 探讨血清降钙素原(PCT)、可溶性尿激酶型纤溶酶原激活物受体(SuPAR)联合急性生理与慢性健康Ⅱ(APACHE Ⅱ)评分及序贯器官功能衰竭(SOFA)评分对脓毒性休克患者预后的评估价值.方法 将157例脓毒性休克患者以3:1的比例分为训练集(118例)和测试集(39例),再根据28d生存情况将训练集患者分为存活组(87例)和死亡组(31例).收集所有患者一般临床资料及实验室检查结果并分组进行比较.通过LASSO回归和多因素logistic回归分析评估脓毒性休克患者死亡的独立危险因素.采用受试者工作特征(ROC)曲线评价各指标对脓毒性休克患者预后的预测价值.通过R软件构建列线图预测模型,分别应用曲线下面积(AUC)、C-index、Hosmer-Lemeshow拟合优度检验对模型的区分度和精准度进行评估.采用决策曲线分析判断列线图的临床效能.结果 死亡组脓毒性休克患者血清PCT、SuPAR、胱抑素C(Cys-C)、乳酸(Lac)水平及APACHE Ⅱ评分、SOFA评分均高于存活组,D二聚体(D-D)水平明显低于存活组(P＜0.05).多因素logistic回归分析结果显示APACHE Ⅱ评分、SOFA评分、PCT、SuPAR及Lac均为影响脓毒性休克患者死亡的独立危险因素(P＜0.05).ROC曲线分析结果显示,血清PCT、血清SuPAR、Lac、SOFA评分及APACHE Ⅱ评分5项指标单独及联合预测脓毒性休克患者死亡价值均较高,且5项指标联合预测的曲线下面积(AUC)均大于单一指标(P＜0.05).依据5个独立影响因素构建的列线图预测模型具有较高的区分度、准确性和临床适用性.结论 PCT、SuPAR、Lac、APACHE Ⅱ评分及SOFA评分与脓毒性休克患者预后密切相关,结合该5项指标构建的列线图模型可为临床提供参考.
Abstract
Objective To explore the prognostic value of serum procalcitonin(PCT),soluble urokinase-type plasminogen activator receptor(SuPAR)combined with acute physiology and chronic health Ⅱ(APACHE Ⅱ)score and sequential organ failure(SOFA)score in patients with septic shock.Methods A tatol of 157 patients with septic shock were divided into training group(118 cases)and test group(39 cases)according to the ratio of 3:1,and then the patients in training group were divided into survival group(87 cases)and death group(31 cases)according to the 28-day survival situation.General clinical data and laboratory examination results of all patients were collected and compared in groups.The independent risk factors of death in septic shock patients were evaluated by LASSO regression and multivariate logistic regression analysis.The predictive value of each index on the prognosis of patients with septic shock was evaluated by receiver operating characteristics(ROC)curve.Nomogram prediction model was built by R software,and the discrimination and accuracy of the model were evaluated by the area under curve(AUC),C-index and Hosmer-Lemeshow goodness-of-fit tests.Clinical efficacy of nomogram was judged by decision curve analysis.Results Serum PCT,SuPAR,Cystatin C(Cys-C),Lactic acid(Lac),APACHE Ⅱ score and SOFA score in death group were higher than those in survival group,and the level of D dimer(D-D)was significantly lower than that in survival group(P＜0.05).Multivariate logistic regression analysis showed that APACHE Ⅱ score,SOFA score,PCT,SuPAR and Lac were independent risk factors for the death of septic shock patients(P＜0.05).ROC curve analysis results showed that serum PCT,serum SuPAR,Lac,SOFA score and APACHE Ⅱ score had higher value in predicting death of patients with septic shock alone and in combination,and the area under the curve(A UC)predicted by the combination of the five indicators was greater than that predicted by a single indicator(P＜0.05).The nomogram prediction model based on five independent influencing factors had high discrimination,accuracy and clinical applicability.Conclusion PCT,SuPAR,Lac,APACHE Ⅱ score and SOFA score are closely related to the prognosis of patients with septic shock,and the nomogram model constructed with the 5 indicators can provide reference for clinic.
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