目的 探讨淋巴细胞计数(lymphocyte count,LYM)、白细胞介素-6(interleukin-6,IL-6)、D-二聚体(D-dimer,DD)联合检测对脓毒症患者28天预后的预测价值.方法 回顾性选取2023年1～11月新疆维吾尔自治区人民医院收治的符合脓毒症3.0诊断标准的患者.收集患者的临床资料,根据28天生存情况进行分组,比较LYM、IL-6、DD水平;绘制受试者工作特征(receiver operating characteristic,ROC)曲线并计算曲线下面积(area under the curve,AUC),根据ROC曲线确定的截断值绘制28天Kaplan-Meier生存曲线.结果 最终纳入脓毒症患者107例,28天生存66例,死亡41例.死亡组DD、IL-6水平较生存组明显升高,LYM水平较生存组明显下降,组间差异有统计学意义(P＜0.05).多因素COX回归分析结果显示,LYM、IL-6、DD均是患者28天死亡的危险因素(P＜0.05).ROC曲线分析结果显示,LYM、IL-6及DD联合检测的AUC大于单独检测(0.909 vs 0.821、0.788、0.807).Kaplan-Meier 生存曲线分析结果显示,LYM 水平 ≤0.52 × 109/L 的患者较 LYM 水平＞0.52 × 109/L 的患者28天生存率随时间延长明显下降;IL-6水平≥551.45pg/ml的患者较IL-6水平＜551.45pg/ml的患者28天生存率随时间延长明显下降;DD水平≥3.25mg/L的患者较DD水平＜3.25mg/L的患者28天生存率随时间延长明显下降.结论 DD、IL-6和LYM对预测脓毒症28天预后均有价值,3项指标联合检测优于单独指标检测,期望可以为临床医生在脓毒症诊疗中提供帮助.
Prognostic Value of LYM,IL-6 and DD on 28 Days Prognosis of Patients with Sepsis
Objective To investigate the predictive value of lymphocyte count(LYM),interleukin-6(IL-6)and D-dimer(DD)combined detection on the 28 day prognosis of patients with sepsis.Methods Patients with sepsis 3.0 admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from January 2023 to November 2023 were retrospectively selected.The clinical data of pa-tients were collected and divided into groups according to their survival at 28 days,and the levels of LYM,IL-6 and DD were compared.Draw the receiver operating characteristic(ROC)curve and calculate the area under the curve(AUC),the 28 days Kaplan-Meier sur-vival curve was plotted according to the cut-off value determined by the ROC curve.Results Finally,107 patients with sepsis were in-cluded,of which 66survived and 41 died within 28days.The levels of DD and IL-6 in the death group were significantly higher than those in the survival group,and the level of LYM was significantly lower than that in the survival group,and the difference between groups was statistically significant(P＜0.05).The results of multivariate COX regression analysis showed that LYM,IL-6 and DD were all risk factors for 28days death(P＜0.05).The results of ROC curve analysis showed that the AUC of LYM,IL-6 and DD combined detection was greater than that of single detection(0.909 vs 0.821,0.788,0.807).The results of Kaplan-Meier survival curve analysis showed that the 28days survival rate of patients with LYM≤0.52 × 109/L was significantly lower than that of patients with LYM＞0.52 × 109/L.The 28 days survival rate of patients with IL-6 ≥551.45pg/ml was significantly lower than that of patients with IL-6＜551.45pg/ml.The 28 days survival rate of patients with DD≥3.25mg/L was significantly lower than that of patients with DD＜3.25mg/L.Conclusion DD,IL-6 and LYM are all valuable in predicting the 28d prognosis of sepsis,and the combined detection of the three indicators is better than the single detection,which is expected to provide help for clinicians in the diagnosis and treatment of sepsis.
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