摘要
目的 探讨血钾、乳酸以及红细胞分布宽度(RDW)/血小板计数(PLT)在血流感染脓毒症休克患者病情和预后的诊断价值.方法 本研究选择2016年2月-2024年2月于天津市泰达医院接受治疗的50例血流感染脓毒症休克患者作为研究组,同时选取同期于医院接受治疗的50例未发生脓毒症休克的血流感染患者为对照组.根据治疗后患者28 d生存状况,将研究组进一步细分为存活组和死亡组以探究不同治疗策略对患者预后的影响.分析各组患者的血钾、乳酸和RDW/PLT水平差异,并归纳血流感染脓毒症休克的危险因素.另外采用受试者工作特征(ROC)曲线并计算曲线下面积(AUC),评估血钾、乳酸和RDW/PLT水平在血流感染脓毒症休克的诊断和预测的诊断价值.结果 研究组血钾、乳酸和RDW/PLT分别为(4.13±0.58)mmol/L、(2.86±0.37)mmol/L和0.16±0.05 高于对照组(P＜0.05).血钾(OR=1.411,95％CI:1.003～1.948)、乳酸(OR=1.519,95％CI:1.237～1.866)和RDW/PLT(OR=1.226,95％CI:1.173～1.782)是血流感染脓毒症休克的危险因素(P＜0.05).血钾、乳酸和RDW/PLT及三者联合诊断脓毒症休克并发血流感染的AUC分别为0.762、0.920、0.775和0.954;随访28 d,死亡组血钾、乳酸和 RDW/PLT 水平分别为(4.37±0.62)mmol/L、(3.09±0.34)mmol/L 和0.20±0.07 均高于存活组(P＜0.05).血钾、乳酸和RDW/PLT三项指标联合应用时,对血流感染脓毒症休克患者预后的预测效能最高,AUC值为0.867.结论 血钾、乳酸和RDW/PLT水平与合并血流感染的脓毒症休克患者的病情程度密切相关,可影响患者的预后,可作为脓毒症休克并发血流感染病情和预后预测的潜在临床指标.
Abstract
OBJECTIVE To investigate the diagnostic value of blood potassium,lactic acid,and red blood cell distri-bution width(RDW)/platelet count(PLT)in the condition and prognosis of patients with septic shock from bloodstream infections.METHODS Totally 50 patients with septic shock due to bloodstream infection treated at Tianjin Teda Hospital from Feb.2016 to Feb.2024 were selected as the study group,and 50 patients with blood-stream infection who did not experience septic shock treated at the same hospital during the same period were se-lected as the control group.According to the survival status of the patients at 28 d after treatment,the study group was further subdivided into the survival group and the death group to investigate the impact of different treatment strategies on the prognosis of the patients.Differences in the levels of blood potassium,lactic acid,and RDW/PLT levels were analyzed in each group of patients and the risk factors for bloodstream infectious septic shock were summarized.Additionally,a receiver operating characteristic(ROC)curve was plotted and the area under the curve(AUC)was calculated to assess the diagnostic and predictive value of blood potassium,lactate,and RDW/PLT ratio levels in bloodstream infectious septic shock.RESULTS Blood potassium,lactic acid,and RDW/PLT ratio in the study group were(4.13±0.58)mmol/L,(2.86±0.37)mmol/L,and(0.16±0.05),re-spectively,significantly higher than those of the control group(P＜0.05).Blood potassium(OR=1.411,95％CI:1.003-1.948),lactic acid(OR=1.519,95％CI:1.237-1.866),and RDW/PLT ratio(OR=1.226,95％CI:1.173-1.782)were the independent risk factors for septic shock in bloodstream infections(P＜0.05).The AUC values of blood potassium,lactic acid,and RDW/PLT ratio alone and combined detection for the diag-nosis of septic shock complicated with bloodstream infection were 0.762,0.920,0.775 and 0.954,respectively.After 28-day of follow-up,blood potassium,lactic acid,and RDW/PLT levels in the death group were(4.37±0.62)mmol/L,(3.09±0.34)mmol/L,and 0.20±0.07,respectively,significantly higher than those in the survi-vor group(P＜0.05).The combined application of blood potassium,lactic acid,and RDW/PLT demonstrated the highest prognostic efficacy in patients with septic shock and bloodstream infection,with an AUC value of 0.867.CONCLUSION Blood potassium,lactic acid,and RDW/PLT ratio were closely related to the degree of condition of septic shock patients with coexisting bloodstream infections,which could affect the prognosis of the patients,and could be used as potential clinical indicators for the prediction of the condition and prognosis of septic shock with coexisting bloodstream infections.
维普
万方数据