摘要
背景目前脓毒症仍具有较高的发病率和死亡率,对其预后的评估方法一直是研究的热点。近年来临床上越来越多地将国家早期预警评分(NEWS)、肾上腺髓质中段肽(MR-proADM)及降钙素原(PCT)应用于评估脓毒症患者的预后,但评估效能中等。三者联合是否有更高的评估效能,尚缺乏相关研究。目的探讨NEWS联合MR-proADM及PCT对脓毒症患者预后的预测价值,以期为急诊科医生对脓毒症患者的预后做出有效评估提供帮助。方法回顾性选取2016年6月—2019年6月海南医学院第二附属医院急诊科收治的脓毒症患者112例为研究对象。收集患者一般资料、NEWS、MR-proADM及PCT水平。根据患者28 d预后情况将其分为死亡组和存活组。采用Logistic回归分析探讨脓毒症患者28 d死亡的危险因素;绘制受试者工作特征曲线(ROC曲线)并评估各指标对脓毒症患者28 d死亡的预测价值。结果随访28 d后24例(21.4%)患者死亡(死亡组),88例(78.6%)患者存活(存活组)。死亡组年龄、NEWS、MR-proADM、PCT高于存活组(P<0.05)。NEWS>1~3、>3~5、>5分患者死亡率高于NEWS≤1分患者,NEWS>5分患者死亡率高于NEWS>1~3分患者(P<0.05);MR-proADM>4.6 nmol/L患者死亡率高于MR-proADM≤1.2、>1.2~2.5 nmol/L患者(P<0.05);PCT>3.6μg/L患者死亡率高于PCT≤0.8、>0.8~1.4μg/L患者(P<0.05)。多因素Logistic回归分析结果显示,NEWS〔OR=1.321,95%CI(1.070,1.630)〕、MR-proADM〔OR=1.254,95%CI(1.062,1.480)〕、PCT〔OR=1.179,95%CI(1.049,1.326)〕为脓毒症患者28 d死亡的危险因素(P<0.05)。NEWS、MR-proADM、PCT三者联合预测脓毒症患者28 d死亡的ROC曲线下面积(AUC)大于NEWS、MR-proADM、PCT单独预测脓毒症患者28 d死亡的AUC(Z=2.670,P=0.007;Z=2.104,P=0.043;Z=2.449,P=0.014)。结论NEWS、MR-proADM、PCT与脓毒症患者预后密切相关,为28 d死亡的独立危险因素,三者联合能有效评估脓毒症患者的预后。
Background At present,sepsis still has high morbidity and mortality,and the evaluation method of its prognosis has been a hot topic.In recent years,the national early warning score(NEWS),midregional-proadrenomedullin(MR-proADM)and procalcitonin(PCT)have been widely used to independently evaluate the prognosis in patients with sepsis,but the evaluation efficiency of each of them is moderate.Whether the combination of the three has higher evaluation efficiency is still lack of relevant research.Objective To explore the prognostic value of NEWS combined with MR-proADM and PCT in patients with sepsis,to provide help for emergency physicians to make an appropriate evaluation of the prognosis of such patients.Methods A total of 112 patients with sepsis admitted to Department of Emergency,the Second Affiliated Hospital ofHainan Medical University from June 2016 to June 2019 were retrospectively selected.General data,NEWS,MR-proADM and PCT were collected.The patients were divided into the survival group and death group according to 28-day prognosis.The risk factors for 28-day mortality were explored by Logistic regression analysis.And the receiver operating characteristic(ROC)curve analysis was performed to evaluate the value of NEWS,MR-proADM and PCT,alone or in combination,in predicting 28-day mortality.Results During the 28 days of follow-up,88(78.6%)patients survived(survival group),and 24(21.4%)died(death group).The mean age,and mean levels of NEWS,MR-proADM and PCT in the death group were greater than those of survival group(P<0.05).The mortality of patients with NEWS>1-3,>3-5,>5 was higher than that of those with NEWS≤1(P<0.05).And the mortality of patients with NEWS>5 was higher than that of those with NEWS>1-3(P<0.05).The mortality of patients with MR-proADM>4.6 nmol/L was higher than that of those with MR-proADM≤1.2 or>1.2-2.5 nmol/L(P<0.05).The mortality of patients with PCT>3.6μg/L was higher than that of those with PCT≤0.8 or>0.8-1.4μg/L(P<0.05).Multivariate Logistic regression analysis showed that NEWS〔OR=1.321,95%CI(1.070,1.630)〕,MR-proADM〔OR=1.254,95%CI(1.062,1.480)〕and PCT〔OR=1.179,95%CI(1.049,1.326)〕were independently associated with 28-day mortality(P<0.05).The area under the ROC curve(AUC)of NEWS combined with MR-proADM and PCT for predicting 28-day mortality was significantly greater than that of each marker alone(Z=2.670,P=0.007;Z=2.104,P=0.043;Z=2.449,P=0.014).Conclusion NEWS,MR-proADM and PCT were closely related to the prognosis,and were independently associated with 28-day mortality in patients with sepsis.The combination of the three had higher capability to predict 28-day mortality than each alone.
作者
王惠文
邢柏
WANG Huiwen;XING Bo(Department of Emergency,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China)
出处
《中国全科医学》
CAS
北大核心
2020年第21期2647-2652,共6页
Chinese General Practice
基金
海南省自然科学资金资助项目(819MS128)。
关键词
脓毒症
国家早期预警评分
肾上腺髓质中段肽
降钙素原
预后
预测
Sepsis
National early warning score
Midregional-proadrenomedullin
Procalcitonin
Prognosis
Forecasting
