降钙素原清除率及序贯器官衰竭估计评分对脓毒症患者预后的预测价值

doi:10.3969/j.issn.1004-583X.2022.03.005

摘要/Abstract

摘要：

目的探讨降钙素(procalcitonin, PCT)、降钙素原清除率(procalcitonin clearance, PCTc)与序贯器官衰竭估计(sequential organ failure assessment, SOFA)评分变化对脓毒症患者预后的预测价值。方法回顾性分析60例脓毒症患者的临床资料。根据入组0 h、24 h、48 h、72 h及120 h的PCT,分别计算其PCTc;记录入组0 h、48 h的SOFA评分,并计算48 h△SOFA。根据患者28 d生存情况,将患者分为存活组(44例)和死亡组(16例),分析两组不同时点PCT及PCTc的差别,采用多因素Cox回归分析探究脓毒症患者预后的影响因素,通过受试者工作特征(receiver operating characteristic, ROC)曲线评价不同指标对脓毒症患者预后的评估能力。结果两组PCT比较差异有统计学意义、时间与处理因素的交互作用差异有统计学意义(均P<0.05),不同时点间差异无统计学意义(P>0.05);与死亡组比较,存活组120 h的PCT较低,差异有统计学意义(P<0.05)。两组PCTc比较差异有统计学意义、不同时点间的差异有统计学意义,时间与处理因素的交互作用差异有统计学意义(均P<0.05);与死亡组比较,存活组24 h、48 h、72 h、120 h的PCTc较高,差异有统计学意义(均P<0.05)。与死亡组比较,存活组入组当时的SOFA评分较低,48 h△SOFA较高(均P<0.05)。多因素Cox回归分析结果显示,年龄>65岁、24 h的 PCTc、120 h 的PCTc、入组当时的SOFA评分和48 h△SOFA是脓毒症患者28 d死亡的独立影响因素。ROC曲线结果显示,120 h的PCTc的曲线下面积(area under the curve, AUC)为0.958,可作为判断预后指标。结论 PCTc较PCT绝对值是判断脓毒症预后更好的指标,24 h的PCTc, 120 h的PCTc、入组当时的SOFA评分和48 h△SOFA是脓毒症患者28 d死亡的独立影响因素, 且120 h的PCTc在评估脓毒症患者预后方面具有较好的临床价值。

关键词: 脓毒症, 预后, 降钙素, SOFA评分

Abstract:

Objective To investigate the predictive value of procalcitonin (PCT), and procalcitonin clearance (PCTc) and the dynamic changes of sequential organ failure assessment (SOFA) score on the prognosis of patients with severe sepsis. Methods The clinical data of 60 patients with severe sepsis were analyzed using a retrospective study. The PCTc were calculated based on the PCT at 0 h, 24 h, 48 h, 72 h and 120 h of enrollment, and the SOFA scores at 0 h and 48 h of enrollment were recorded, and the △SOFA at 48 h was figured out. The patients were divided into survival (n=44) and death group (n=16) according to whether they died at 28 d, and the interclass differences of PCT and PCTc at different time points were analyzed. Multivariate Cox regression analysis was used to explore the influencing factors of the prognosis of these patients, and the receiver operating characteristic (ROC) curve was used to verify the assessment ability of different indicators for the prognosis. Results There were statistically significant differences in PCT between groups, and the interaction between time and treatment factors was statistically significant (all P<0.05), but there was no significant difference between different time points (P>0.05). Compared with the death group, the PCT at 120 h in the survival group was significantly lower (P<0.05). The differences in PCTc between groups were statistically significant, the differences between different time points were statistically significant, and the interaction between time and treatment factors was statistically significant (all P<0.05). PCTc at 24 h, 48 h, 72 h, 120 h in the survival group were significantly higher (all P<0.05). Compared with the death group, the SOFA score of the survival group at enrollment was lower, and the△SOFA score at 48 h was significantly higher (all P<0.05). Multivariate Cox regression analysis showed that age>65 years old, PCTc at 24 h, PCTc at 120 h, SOFA score at enrollment and △SOFA at 48 h was an independent factor for the 28-day death of sepsis patients. The ROC curve results showed that the area under the curve (AUC) of PCTc at 120 h was 0.958, which could be used as a prognostic indicator. Conclusion Compared with the absolute value of PCT, PCTc is an indicator for judging the prognosis of sepsis. PCTc at 24 h, PCTc at 120 h, SOFA score at enrollment and △SOFA at 48 h are the independent influencing factors for the 28 d-death of sepsis patients. PCTc at 120 h can be used as an assessment tool for the prognosis of sepsis patients.

Key words: sepsis, prognosis, calcitonin, SOFA score

中图分类号:

R631

张孟媛, 朱勇. 降钙素原清除率及序贯器官衰竭估计评分对脓毒症患者预后的预测价值[J]. 临床荟萃, 2022, 37(3): 225-229.

Zhang Mengyuan, Zhu Yong. Predictive value of procalcitonin clearance and SOFA score on the prognosis of patients with severe sepsis[J]. Clinical Focus, 2022, 37(3): 225-229.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.03.005

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I3/225

图/表 6

参考文献 19

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项目	存活组 (n=44)	死亡组 (n=16)	t/χ²值	P值
性别[例(%)]
男女	30(68.2) 14(31.8)	9(56.3) 7(43.7)	0.065	0.782
年龄(岁)	63.94±12.36	68.90±12.91	-1.986	0.009
体温(℃)	37.88±0.69	37.62±0.75	1.236	0.675
收缩压(mm Hg)	109.64±23.64	117.23±24.01	2.161	0.198
舒张压(mm Hg)	79.97±12.05	79.31±10.27	0.276	0.843
呼吸频率(次/min)	19.25±3.78	21.46±4.87	-3.725	0.421
感染部位[例(%)]
腹腔	19(43.1)	7(43.7)	0.009	0.941
肺	9(20.4)	4(25.0)	0.401	0.594
尿路	8(18.1)	3(18.7)	1.047	0.246
中枢	2(4.6)	0(0)	0.371	0.500
血行	6(13.6)	2(12.5)	1.214	0.298
合并症[例(%)]
糖尿病	6(13.6)	7(43.7)	5.445	0.021
高血压	22(50.8)	9(56.2)	3.485	0.055
慢性肺病	11(25.0)	4(27.5)	0.514	0.489
冠心病	8(35.2)	4(27.5)	0.024	0.864
肝胆疾病	7(16.1)	3(18.7)	1.127	0.307
慢性肾病	14(34.1)	5(31.4)	1.356	0.275

项目	存活组 (n=44)	死亡组 (n=16)	t/χ²值	P值
性别[例(%)]
男女	30(68.2) 14(31.8)	9(56.3) 7(43.7)	0.065	0.782
年龄(岁)	63.94±12.36	68.90±12.91	-1.986	0.009
体温(℃)	37.88±0.69	37.62±0.75	1.236	0.675
收缩压(mm Hg)	109.64±23.64	117.23±24.01	2.161	0.198
舒张压(mm Hg)	79.97±12.05	79.31±10.27	0.276	0.843
呼吸频率(次/min)	19.25±3.78	21.46±4.87	-3.725	0.421
感染部位[例(%)]
腹腔	19(43.1)	7(43.7)	0.009	0.941
肺	9(20.4)	4(25.0)	0.401	0.594
尿路	8(18.1)	3(18.7)	1.047	0.246
中枢	2(4.6)	0(0)	0.371	0.500
血行	6(13.6)	2(12.5)	1.214	0.298
合并症[例(%)]
糖尿病	6(13.6)	7(43.7)	5.445	0.021
高血压	22(50.8)	9(56.2)	3.485	0.055
慢性肺病	11(25.0)	4(27.5)	0.514	0.489
冠心病	8(35.2)	4(27.5)	0.024	0.864
肝胆疾病	7(16.1)	3(18.7)	1.127	0.307
慢性肾病	14(34.1)	5(31.4)	1.356	0.275

组别	例数	PCT_{0 h}	PCT_{24 h}		PCT_{48 h}		PCT_{72 h}		PCT_{120 h}
存活组	44	0.65±0.07	0.74±0.17		0.94±0.24		0.89±0.24		0.64±0.38^*
死亡组	16	1.48±0.14	1.32±0.36		0.89±0.53		0.98±0.52		0.82±0.74^*
组间		F=6.929 P=0.011
不同时点		F=1.089 P=0.373
组间·不同时点		F=8.441 P=0.000
组别	例数	PCTc_{24 h}		PCTc_{48 h}		PCTc_{72 h}		PCTc_{120 h}
存活组	44	0.10±0.32^#		0.35±0.22^#		0.64±0.10^*		0.82±0.08^#
死亡组	16	-0.59±0.83^#		-1.58±2.32^#		-0.24±1.02^*		-0.11±0.89^#
组间		F=32.027 P=0.000
不同时点		F=39.449 P=0.000
组间·不同时点		F=5.781 P=0.002

组别	例数	PCT_{0 h}	PCT_{24 h}		PCT_{48 h}		PCT_{72 h}		PCT_{120 h}
存活组	44	0.65±0.07	0.74±0.17		0.94±0.24		0.89±0.24		0.64±0.38^*
死亡组	16	1.48±0.14	1.32±0.36		0.89±0.53		0.98±0.52		0.82±0.74^*
组间		F=6.929 P=0.011
不同时点		F=1.089 P=0.373
组间·不同时点		F=8.441 P=0.000
组别	例数	PCTc_{24 h}		PCTc_{48 h}		PCTc_{72 h}		PCTc_{120 h}
存活组	44	0.10±0.32^#		0.35±0.22^#		0.64±0.10^*		0.82±0.08^#
死亡组	16	-0.59±0.83^#		-1.58±2.32^#		-0.24±1.02^*		-0.11±0.89^#
组间		F=32.027 P=0.000
不同时点		F=39.449 P=0.000
组间·不同时点		F=5.781 P=0.002

SOFA评分 (分)	存活组 (n=44)	死亡组 (n=16)	t值	P值
SOFA_{0 h}	6.43±2.55	13.56±2.83	-8.864	<0.01
48 h△SOFA	1.61±1.63	-1.31±1.66	6.060	<0.01