摘要
目的:探讨急性生理与慢性健康Ⅱ(APACHEⅡ)评分联合血清降钙素原(PCT)、D-二聚体(D-D)、乳酸清除率(LCR)对脓毒症患者预后不良的预测价值。方法:回顾性分析92例在我院就诊的脓毒症患者的临床资料,根据患者28 d预后情况分为预后良好组和预后不良组。对比2组患者入院时APACHEⅡ评分、血清PCT、D-D水平和入院6 h的LCR水平,并采用受试者工作特征(ROC)曲线评价APACHEⅡ评分联合血清PCT、D-D、LCR对脓毒症患者预后不良的预测价值。结果:患者28 d预后不良率为21.74%,预后不良患者的APACHEⅡ评分、血清PCT、D-D水平均高于预后良好患者(P<0.05),入院6 h的LCR低于预后良好患者(P<0.05);APACHEⅡ评分、血清PCT、D-D、LCR预测脓毒症患者预后不良的Cut-off值分别为14分、1.78μg/L、1.48 mg/L、20.50%,APACHEⅡ评分联合血清PCT、D-D、LCR预测脓毒症预后不良的敏感度、特异度、AUC分别为95.00%、86.11%、0.976,AUC均高于单独预测,差异均有统计学意义(P<0.05)。结论:脓毒症预后不良患者有较高的APACHEⅡ评分、血清PCT、D-D和较低的LCR,APACHEⅡ评分联合血清PCT、D-D、LCR对脓毒症预后不良有较好的预测价值,可用于临床指导治疗。
Objective:To investigate the predictive value of acute physiological and chronic healthⅡ(APACHEⅡ)score combined with serum procalcitonin(PCT),D-dimer(D-D)and lactate clearance rate(LCR)in patients with severe sepsis.Method:The clinical datas of 92 patients with severe sepsis admitted to the hospital were retrospectively analyzed,and the patients were divided into good prognosis group and poor prognosis group according to the prognosis of 28 days.APACHEⅡscores,levels of serum PCT,D-D at admission and LCR levels after 6 h were compared between the two groups.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of APACHEⅡscores combined with serum PCT,D-D and LCR for poor prognosis of patients with severe sepsis.Result:The 28-day poor prognosis rate was 21.74%,patients with poor prognosis had higher APACHEⅡscores,serum PCT contents and D-D levels than those with good prognosis(P<0.05),while the LCR at 6 h of admission was lower(P<0.05).The cut-off values of APACHEⅡscores,serum PCT,D-D and LCR for predicting the poor prognosis of patients with severe sepsis were 14 points,1.78 ug/L,1.48 mg/L and 20.50%,respectively.The sensitivity,specificity and AUC of the combination of APACHEⅡscores,serum PCT,D-D and LCR for predicting poor prognosis of severe sepsis were 95.00%,86.11%and 0.976,respectively.The AUC was higher than those of the single prediction,with statistically significant differences(P<0.05).Conclusion:Patients with severe sepsis with poor prognosis had higher APACHEⅡscores,serum PCT,D-D,and lower LCR.The combination of APACHEⅡscores,serum PCT,D-D and LCR has a good predictive value on poor prognosis of severe sepsis,which can be used to guide clinical treatment.
作者
王子文
王登基
徐晓梅
赵文静
WANG Ziwen;WANG Dengji;XU Xiaomei;ZHAO Wenjing(Department of Intensive Care Unit,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu,221000,China)
出处
《临床急诊杂志》
CAS
2021年第2期126-130,共5页
Journal of Clinical Emergency
关键词
急性生理与慢性健康评分
降钙素原
D-二聚体
乳酸清除率
脓毒症
预后
acute physiology and chronic health score
procalcitonin
d-dimer
lactate clearance rate
severe sepsis
prognosis
