摘要
目的 研究急诊危重症患者30 d死亡的影响因素及D-二聚体、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)与急诊危重症患者30 d内死亡的相关性.方法 收集2015年12月至2020年12月沧州市人民医院收治的急诊危重症患者的入院24 h内临床生化指标、序贯器官衰竭评分(sequential organ failure assessment,SOFA)得分、急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)得分等临床资料,根据入院后30 d生存情况将患者分为生存组和死亡组.使用Logistic回归分析影响急诊危重症患者30 d死亡的危险因素.使用受试者工作特征(receiver operating characteristic,ROC)曲线评价SOFA得分、APACHE Ⅱ得分、D-二聚体、NLR对急诊危重症患者30 d死亡的预测价值.结果 共纳入1 595例急诊危重症患者,其中生存组1 359例,死亡组236例.与生存组相比,死亡组纤维蛋白原、凝血酶原时间、白细胞计数、中性粒细胞计数、NLR、血小板计数、血乳酸、D-二聚体水平及SOFA得分、APACHE Ⅱ得分较高(P＜0.05),淋巴细胞计数较低(P＜0.05).Logistic 回归分析显示,NLR[OR=2.078,95％CI(1.245,3.466)]、D-二聚体[OR=1.876,95％CI(1.313,2.680)]、SOFA 得分[OR=1.626,95％CI(1.152,2.296)]、APACHE Ⅱ 得分[OR=1.597,95％CI(1.103,2.313)]是急诊危重症患者30 d死亡的影响因素(P＜0.05).ROC曲线分析显示,SOFA得分、APACHE Ⅱ得分预测急诊危重症患者30 d死亡的曲线下面积(area under curve,AUC)分别为 0.818[95％CI(0.794,0.842)]、0.810[95％CI(0.783,0.838)];NLR 联合 D-二聚体的 AUC 为 0.965[95％CI(0.957,0.973)].结论 入院后 24 h 内 NLR、D-二聚体、SOFA得分、APACHE Ⅱ得分是急诊危重症患者30 d死亡的影响因素,NLR、D-二聚体可作为急诊危重症患者30 d死亡的敏感预测指标.
Abstract
Objective To study the influencing factors of 30 d mortality in emergency severely ill patients and the correlation between D-dimer,neutrophil to lymphocyte ratio(NLR),and early death in emergency severely ill patients.Methods The clinical data of severely ill patients admitted to Cangzhou People's Hospital from December 2015 to December 2020,including clinical biochemical indicator,sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score within 24 hours of admission were collected.According to the 30 d prognosis,the patients were separated into the survival group and the death group.Logistic regression was performed to analyze the risk factors for 30 d death in severely ill patients.The receiver operating characteristic(ROC)curve was performed to evaluate the predictive value of SOFA score,APACHE Ⅱ score,D-dimer and NLR on 30 d death in severely ill patients.Results 1 595 severely ill patients were included,with 1 359 in the survival group and 236 in the death group.Compared with the survival group,the death group had higher fibrinogen,prothrombin time,white blood cell count,neutrophil count,NLR,platelet count,blood lactate,D-dimer level,SOFA score and APACHE Ⅱ score and lower lymphocyte count(P＜0.05).Logistic analysis showed that NLR[OR=2.087,95％CI(1.245,3.466)],D-dimer[OR=1.876,95％CI(1.313,2.680)],SOFA score[OR=1.626,95％CI(1.152,2.296)],and APACHE Ⅱ score[OR=1.597,95％CI(1.103,2.313)]were risk factors for 30 d death in severely ill patients(P＜0.05).The ROC curve analysis showed that the area under curve(AUC)of SOFA score and APACHE Ⅱ score for predicting 30 d death in severely ill patients was 0.818[95％CI(0.794,0.842)]and 0.810[95％CI(0.783,0.838)]respectively.The AUC of NLR combined with D-dimer for predicting 30 d death in severely ill patients was 0.965[95％CI(0.957,0.973)].Conclusion NLR,D-dimer,SOFA score,and APACHE Ⅱ score within 24 h of admission are influencing factors for 30 d mortality in emergency severely ill patients.NLR and D-dimer can serve as sensitive predictive indicators for 30 d mortality in emergency severely ill patients.
维普
万方数据