摘要
目的:探讨血钙在评估脓毒症患者死亡风险中的预测价值.方法:本研究采用回顾性观察的研究方法,收集了 2021年1月至2022年3月期间在我院急诊科抢救室治疗的229例脓毒症患者的基本信息和实验室数据,并对其进行分析.结果:在纳入的患者中,死亡组62例,生存组167例.死亡组的年龄、心率、APACHE Ⅱ评分、白细胞计数、中性粒细胞绝对值、CRP、降钙素、尿素氮、基础疾病脑血管病的发病率高于存活组,差异有统计学意义(P均＜0.05);死亡组血清总钙、离子钙、白蛋白、淋巴细胞绝对值、收缩压、舒张压、血红蛋白、红细胞压积、基础疾病慢性阻塞性肺疾病的发病率低于存活组,差异有统计学意义(P均＜0.05).多因素回归分析显示,离子钙、APACHEⅡ评分、白蛋白是影响脓毒症患者预后的危险因素.受试者工作特征(ROC)曲线下的面积分别为离子钙(0.722),APACHE Ⅱ评分(0.807)、白蛋白(0.751),对脓毒症患者预后的预测作用较好;离子钙联合APACHE Ⅱ评分预测的AUC值为0.843,其联合预测效果优于单独应用离子钙、白蛋白、APACHE Ⅱ评分的预测价值(P＜0.001).离子钙联合APACHE Ⅱ评分预测的敏感性为0.726,特异性为0.862.结论:离子钙是影响脓毒症患者预后的独立危险因素,对脓毒症患者死亡结局具有中等预测能力.离子钙联合APACHE Ⅱ评分预测效果更好.
Abstract
Objective:To explore the predictive value of calcium in assessing the risk of death in sepsis.Methods:Data from 229 septic patients who were treated in the emergency department of our hospital between January 2021 and March 2022 were retrospectively analyzed.Results:A total of 62 patients were included in the death group and 167 were included in the survival group.Age,heart rate,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,white blood cell count,absolute neutrophil values,CRP,PCT,usea nitrogen and cerebrovascular disease were higher and total serum calcium,ionic calcium,albumin,absolute lymphocytes values,SBP,DBP,hemoglobin,hematocrit and chronic obstructive pulmonary diseases were lower in the non-survival group than in the surviving group(all P＜0.05).Multivariate regression analysis showed that the ionized calcium,APACHE Ⅱ score and albumin were independent risk factors affecting the prognosis of septic patients.The area under the receiver operating characteristic curve(AUC)values were ionic calcium(0.722),APACHE Ⅱ score(0.807)and albumin(0.751),which predicted the prognosis of sepsis patients well.The AUC value of ionic calcium combined APACHE Ⅱ score was 0.843,which was better than that of ionic calcium,albumin and APACHE Ⅱ score alone(P＜0.001).APACHE Ⅱ combined ionic calcium had a sensitivity of 0.726 and a specificity of 0.862.Conclusions:Ionic calcium is an independent risk factor affecting the outcome of septic patients and has moderate predictive power for mortality outcome in septic patients.Ionic calcium combined with APACHE Ⅱ score has better predictive performance.
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