重症监护室内重症肺炎患者新发血栓事件和病死率的研究分析
Analysis of thrombotic events and mortality in patients with sever pneumonia in intensive care unit
张连芳 1谢榕城 1林雪烽 1马杰飞2
作者信息
- 1. 复旦大学附属中山医院(厦门)重症医学科(福建厦门 361000)
- 2. 复旦大学附属中山医院重症医学科(上海 200032)
- 折叠
摘要
背景 探讨社区获得性肺炎(community acquired pneumonia,CAP)及新型冠状病毒感染(coronavirus disease 2019,COVID-19)所致重症肺炎患者的血栓栓塞症事件的发生率、病死率,并分析其相关高危因素.方法 收集2018年1月-2023年2月期间复旦大学附属中山医院(厦门)重症监护室收治重症肺炎患者161例.根据肺炎类型划分为COVID-19组88例、CAP组73例;根据是否发生血栓,划分为血栓组及非血栓组.收集人口统计学资料、实验室指标,并记录两组患者的血栓栓塞症事件、结局.结果 CAP组中出现24例(32.9％)血栓,均为静脉血栓,无动脉血栓形成;COVID-19组出现32例(36.4％)血栓,其中31例为静脉血栓(2例合并新发脑梗),1例为新发心肌梗死;但两组血栓发生率无显著差异(P＞0.05).血栓组与非血栓组间的性别、年龄、静脉血栓栓塞症评分(venous thromboembolism score,VTE评分)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)及降钙素原(procalcitonin,PCT)差异有统计学意义(P＜0.05).在 Logistics 模型中,血栓发生与性别、年龄及APTT呈相关性;其中,性别[女性比值比(odds ratio,OR)=2.47,95％置信区间(confidential interval,CI)1.13～5.39,P＜0.05)]与年龄(OR=1.04,95％CI 1.01～1.07,P＜0.05)与血栓发生呈正相关.在住院随访中,CAP组和COVID-19组重症肺炎患者的病死率分别为44.3％和42.5％(P＞0.05).将Logistics模型中因素纳入受试者操作特征曲线(receiver operator characteristic curve,ROC曲线),急性生理学和慢性健康状况评价 Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)评分的 ROC 曲线下面积(area under ROC curve,AUC)为 0.77(95％CI 0.70～0.84,敏感性 74.3％,特异性 68.1％),VTE 评分的 AUC 为0.61(95％CI0.53～0.70,敏感性 31.4％,特异性 81.7％),肌酐的 AUC 为 0.64(95％CI0.56～0.73,敏感性 72.9％,特异性51.2％);而肾脏疾病的Kappa值为0.409(P＜0.05),呈现中度一致性.结论 CAP和COVID-19所致的重症肺炎患者的血栓栓塞症事件发生率、病死率均高.血栓发生与性别、年龄及APTT呈相关性;APACHE Ⅱ评分、VTE评分、肌酐值为预测重症肺炎死亡的独立危险因素.
Abstract
Objective To explore the thromboembolic events and mortality in patients with different types of severe pneumonia,and to analyze the related high-risk factors.Methods A total of 161 severe pneumonia patients who admitted in intensive care unit from January 2018 to February 2023 were included in the study.The patients were divided into a COVID-19 group(n=88)and a community-acquired pneumonia(CAP)group(n=73)according to the type of pneumonia,and divided into a thrombosis group and a non-thrombosis group according to the occurrence of thrombosis.The patients were followed-up until discharge or in-hospital death,registering the occurrence of thrombotic events.Results During the in-hospital stay,32.9％of CAP and 36.4％of COVID-19 patients experienced thrombotic events(P＞0.05).In CAP group all the events(including 24 paitents)were venous thromboses,while in COVID-19 group 31 patients were venous and 3 were arterial thromboses(2 were cerebral infarction,and 1 with myocardial infarction).There were statistically significant difference in gender,age,venous thromboembolism score(VTE score),activated partial thromboplastin time(APTT),and procalcitonin(PCT)between the TE group and the Non-TE group.Logistic regression analysis showed that thrombotic events was associated with sex,age and APTT;gender(female:OR=2.47,95％CI 1.13-5.39,P＜0.05)and age(OR=1.04,95％CI 1.01-1.07,P＜0.05)were positively associated with thrombotic events.During the in-hospital follow-up,44.3％of CAP patients and 42.5％of COVID-19 patients died(P＞0.05).Receiver operator characteristic(ROC)curve analysis showed that APACHE Ⅱ score was more accurate in predicting mortality of severe pneumonia,and the area under the ROC curve(AUC)was 0.77(95％CI 0.70-0.84,sensitivity 74.3％,specificity 68.1％),the AUC of the VTE score was 0.61(95％CI 0.53-0.70,Sensitivity 31.4％,specificity 81.7％);the AUC of the creatinine was 0.64(95％CI 0.56-0.73,sensitivity 72.9％,specificity 51.2％).While the Kappa value for kidney disease was 0.409(P＜0.05)presenting moderate consistency.Conclusions The incidence of thromboembolic events and mortality are high in patients with different types of severe pneumonia.Thrombophilia was associated with sex,age,and APTT.APACHE Ⅱscore,VTE score,and creatinine value were independent risk factors for predicting death from severe pneumonia.
关键词
重症肺炎/社区获得性肺炎/新型冠状病毒感染/血栓栓塞症/病死率Key words
Severe pneumonia/community acquired pneumonia/coronavirus disease 2019/thrombotic events/mortality引用本文复制引用
基金项目
福建省自然科学基金(2023J011691)
福建省临床重点专科建设项目(63060405)
复旦大学附属中山医院厦门医院孵化课题(2020ZSXMYYS05)
出版年
2024
NETL
NSTL
万方数据