目的:评价肝素结合蛋白(HBP)联合脏器功能指标对严重创伤合并脓毒症患者预警诊断和预后预测效能评价研究.方法:回顾性分析2019年1月～2020年9月期间入住浙江大学医学院附属第二医院急诊医学科的多发伤并完成HBP检测患者184例,根据SEPSIS 3.0诊断标准将患者分为脓毒症组(n=89)和非脓毒症组(n=95),追踪患者临床结局分为死亡组(n=43)和非死亡组(n=141).连续测定患者HBP水平,比较两组HBP峰值差异,评估其诊断脓毒症的效力,以HBP峰值的中位数为界值进一步分析其与临床预后相关性,评估HBP单独及联合总胆红素(TBil)及白细胞(WBC)评估预后的效力.结果:(1)脓毒症组(n=89)与非脓毒症组(n=95)HBP的峰值(71.7±68.6 vs 52.5±56.1)无显著差异(P=0.051).(2)184例患者中HBP峰值与WBC计数呈正相关(r=0.244,P<0.01),与TBil水平呈正相关(r=0.241,P<0.01).(3)TBil水平、WBC计数及PCT水平独立诊断脓毒症曲线下面积(AUC)分别是:0.618、0.631和0.718,三者联合AUC为0.684,诊断敏感度为60.7%,特异度为71.6%(P<0.05).(4)死亡预后相关分析显示:高HBP水平组患者死亡率要显著高于低水平组(30.4%vs 16.3%,P<0.05);WBC计数值也是死亡组显著高于非死亡组(17.5±6.9 vs 12.8±4.7,P<0.01),尤其合并脓毒症者,该值有显著差异(P<0.01).HBP峰值、TBil水平、WBC计数、SOFA评分及APACHE-II评分对预测脓毒症死亡预后的AUC分别是:0.618、0.603、0.719、0.823及0.811,HBP联合TBil及WBC评估脓毒症预后的AUC为0.750,评估的敏感度为74.4%,特异度为74.5%(P<0.05).(5)三者联合评估在预测脓毒症预后效力上与人工评分差异无统计学意义(P>0.05).结论:HBP、TBil及WBC三者联合用于评估多发伤患者发生脓毒症风险的预测效力较高,对于合并脓毒症的外伤患者死亡风险预测具有较高的临床指导价值.
Efficacy evaluation of combined heparin-binding protein,total bilirubin,and white blood cell count in predicting sepsis in patients with severe trauma
AIM:To evaluate the effectiveness of heparin-binding protein(HBP)in combination with organ function indicators for early diagnosis and prognosis prediction in patients with severe trauma complicated with sepsis.METHODS:A retrospective analysis was conducted on 184 patients with multiple injuries who were admitted to the Emergency Medicine Department of the Second Affiliated Hospital of Zhejiang University Medical College between January 2019 and September 2020 and underwent HBP testing.Patients were classified according to the SEPSIS 3.0 diagnostic cri-teria into a sepsis group(n=89)and a non-sepsis group(n=95).Clinical outcomes were tracked,dividing patients into a deceased group(n=43)and a survival group(n=141).HBP levels were continuously measured,and the peak values of the two groups were compared to assess the efficacy of diagnosing sepsis.Further analysis on the correlation of HBP peak value median with clinical prognosis was conducted.The effectiveness of HBP alone and in combination with total biliru-bin(TBil)and white blood cell(WBC)count in prognosis assessment was evaluated.RESULTS:(1)No significant dif-ference was found in the peak level of HBP between the sepsis group(n=89)and the non-sepsis group(n=95)(71.7±68.6 vs 52.5±56.1,P=0.051).(2)Among the 184 patients,the peak level of HBP was positively correlated with WBC count(r=0.244,P<0.01)and TBil levels(r=0.241,P<0.01).(3)The area under curve(AUC)for independent diag-nosis of sepsis using TBil levels,WBC count,and PCT levels were 0.618,0.631,and 0.718,respectively,and the com-bined AUC was 0.684,with a diagnostic sensitivity of 60.7%and specificity of 71.6%(P<0.05).(4)Prognostic analy-sis of mortality showed that patients in the high HBP level group had a significantly higher mortality rate than those in the low-level group(30.4%vs 16.3%,P<0.05).The WBC count was also significantly higher in the deceased group than in the survival group(17.5±6.9 vs 12.8±4.7,P<0.01),especially in those with sepsis(P<0.01).The AUCs for predict-ing sepsis mortality prognosis using HBP peak level,TBil levels,WBC count,SOFA score,and APACHE-II score were 0.618,0.603,0.719,0.823,and 0.811,respectively.The combined AUC of HBP with TBil and WBC for assessing sepsis prognosis was 0.750,with a sensitivity of 74.4%and specificity of 74.5%,showing statistically significant differ-ences(P<0.05).(5)The combined assessment of these three indicators showed no statistically significant difference from artificial scoring systems in predicting sepsis prognosis(P>0.05).CONCLUSION:The combination of HBP,TBil,and WBC is highly effective in predicting the risk of sepsis in patients with multiple injuries and has significant clinical value in predicting the mortality risk of trauma patients with sepsis.
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