摘要
目的 探讨重症肺炎可溶性髓系细胞触发受体-1(sTREM-1)的动态演变与常规指标预测治疗28d死亡风险的临床价值.方法 回顾性选择2022年1 月至2023年4 月金华市人民医院确诊重症肺炎患者共126 例为研究对象,所有患者根据指南推荐进行综合治疗,根据治疗28d的临床结局分为存活组和死亡组.比较两组常规临床资料和sTREM-1动态演变,多因素logistic回归筛选重症肺炎患者治疗28d死亡的预测因子,Spearman检验进行相关性分析,受试者工作特征(ROC)曲线计算预测因子对重症肺炎患者治疗28d死亡的曲线下面积(AUC).结果 治疗28d的临床结局显示,存活组92 例和死亡组34 例.与存活组比较,死亡组年龄大,入院急性生理与慢性健康评估Ⅱ(APACHE Ⅱ)评分、序贯器官衰竭评估(SOFA)评分、动脉血乳酸、C反应蛋白(CRP)和降钙素原(PCT)水平升高,机械通气时间延长,而氧合指数降低,差异均有统计学意义(t分别=5.03、26.66、3.86、5.43、23.32、16.66、4.86、-30.21,P均＜0.05).死亡组入院1d、3d和7d的sTREM-1水平,△Q1、△Q2、△Q1%和△Q2%sTREM-1值均明显高于存活组,差异均有统计学意义(t分别=20.33、56.52、89.53、16.66、66.52、19.66、35.56,P均＜0.05).入院SOFA评分、血乳酸、△Q2和△Q2%sTREM-1值升高是28d死亡的危险因素(OR分别=1.56、1.76、1.86、1.97,P均＜0.05).Spearman检验显示,△Q2和△Q2%sTREM-1值与SOFA评分和血乳酸呈正相关(rs分别=0.66、0.75、0.71、0.82,P均＜0.05).ROC显示,入院SOFA评分、血乳酸、△Q2和△Q2%sTREM-1值预测28d死亡的AUC分别为0.70、0.78、0.84和0.87,Q2和△Q2%sTREM-1值的预测性能最佳.结论 重症肺炎sTREM-1动态演变与28d死亡风险有关,可成为预测短期临床结局的重要生化标志物,其中△Q2和△Q2%sTREM-1值升高对28d死亡有较好的预测效能.
Abstract
Objective To investigate the predictive value of dynamic evolution of serum trigger receptor expressed my-eloid cell-1(sTREM-1)or conventional indicators for death risk after 28 days treatment in patients with severe pneumo-nia.Methods A total of 126 patients with severe pneumonia in Jinhua People's Hospital from January 2022 to April 2023 were selected.All patients were recommended for comprehensive treatments according to the guidelines,and divided into survival group and death group according to the 28 day clinical outcome.The routine clinical datas and dynamic evo-lution of sTREM-1 were compared,predictive factors for 28 day mortality in severe pneumonia patients were screened us-ing multivariate logistic regression,correlation analysis was made using Spearman correlation analysis,the area under the curve(AUC)was calculated of the predictive factors for 28 day mortality in severe pneumonia patients using receiver op-erating curve(ROC).Results The clinical out-come of 28 days of treatment showed that 92 cases were survival and 34 cases death.Compared to the survival group,the age of death group was older,the scores of APACHE Ⅱ and SOFA on admission,the levels of lactic acid in arterial blood,C-reactive protein and procalcitonin were higher,mechanical ventilation time was longer,while oxygenation index was less(t=5.03,26.66,3.86,5.43,23.32,16.66,4.86,-30.21,P＜0.05).The sTREM-1 levels at 1,3 and 7 days after admission,and the values of △Q1,ΔQ2,△Q1%and △Q2%were significantly higher(t=20.33,56.52,89.53,16.66,66.52,19.66,35.56,P＜0.05).Higher admission SOFA score,blood lac-tic acid,△Q2 and △Q2%sTREM-1 values were strong predictors to death after 28 days treatment(OR=1.56,1.76,1.86,1.97,P＜0.05).The △Q2,△Q2%sTREM-1 values were significantly positively correlated with SOFA score and blood lactic acid(rs=0.66,0.75,0.71,0.82,P＜0.05).ROC showed AUC of admission SOFA score,blood lactic acid,△Q2 and △Q2%sTREM-1 value for predicting death after 28 days treatment for severe pneumonia were 0.70,0.78,0.84 and 0.87.The predictive performance of Q2 and △Q2%sTREM-1 values was the best.Conclusion The dynamic evolu-tion of sTREM-1in the early stage of admission for severe pneumonia is closely related to the death risk after 28 days treatment,which could become important biochemical marker for predicting short-term clinical outcome,among them,the increasing of △Q2 and △Q2%value have good predictive effects for death after 28 days treatment.
基金项目
金华市公益性技术应用研究项目(2022-4-167)
维普
万方数据