摘要
目的探讨肾上腺髓质中段肽(mid-regional proadrenomedullin,MR-proADM)对低风险脓毒症患者不良预后的预测价值。方法本研究为前瞻性队列研究。研究对象为2018年12月至2020年12月中国康复研究中心急诊重症监护室收治的脓毒症患者。将患者按序贯器官衰竭(sequential organ failure assessment,SOFA)评分分为低风险组(SOFA≤7分)和中高风险组(SOFA>7分),比较两组临床特征。采用比例风险回归模型(COX回归模型)分析低风险组和中高风险组患者28d死亡的危险因素。应用受试者工作特征曲线评价MR-proADM、C反应蛋白、乳酸(lacticacid,Lac)白介素6(interleukin-6,IL-6)及SOFA评分、急性生理学及慢性健康状况(acute physiology and chronic health evaluation,APACHE)Ⅱ评分对各组预后的预测能力。并比较低风险组中MR-proADM浓度不同患者的预后。结果共纳入205例脓毒症患者,28d病死率为41.0%(84/205)。两组间器官功能障碍数目、急性肾损伤、血管活性药物使用、LaC、IL-6、SOFA评分和APACHEⅡ评分差异有统计学意义。COX回归模型显示在低风险组中,年龄、MR-proADM、机械通气、IL-6和APACHEⅡ评分是患者28d死亡的危险因素,在中高风险组中,MR-proADM、Lac、SOFA评分和APACHEⅡ评分是患者28d死亡的危险因素。各组中,MR-proADM对患者预后具有良好的预测能力(P<0.001)。尤其在低风险患者中,MR-proADM对患者的预测能力优于其他指标。Kaplan-Meier生存曲线分析提示MR-proADM>2.53nmol/L比MR-proADM≤2.53nmol/L的患者预后差,差异有统计学意义(P<0.001)。在低风险组中,如果MR-proADM>2.53nmol/L,患者的病死率由7.8%上升至58.2%。结论MR-proADM是脓毒症患者28d死亡的危险因素,而且MR-proADM能早期识别低风险患者的不良预后。
Objective To investigate the predictive value of mid-regional proadrenomedullin(MR-proADM)on poor prognosis of low-risk patients with sepsis.Methods This was a prospective cohort study.Patients with sepsis admitted to the Emergency Intensive Care Unit of China Rehabilitation Research Center from December 2018 to December 2020 were included in this study.The patients were divided into the low-risk group(SOFA≤7)and medium-high-risk group(SOFA>7)according to the sequential organ failure assessment(SOFA)score,and the clinical characteristics of the two groups were compared.Proportional hazards regression model(COX regression model)was used to investigate the risk factors of 28-day mortality in the lw-risk and medium high risk group.The pretictive aility of MR proADM,C-reactive protein(CRP),lactic acid(Lac),interleukin-6(IL-6)SOFA score,and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score for the prognosis in cach group was evaluated by rceiver operating characteristie(ROC)curve.The outcomes of paticns with diferent concentration of MR proADM in the low-risk group were compared.Results Totally 205 patients with sepsis were ineluded,and the 28 day mortality was 41.0%(84/205).There were significant diferences in the number of organ dysfunction,acute kidney injury,use of vasoactive drugs,Lac,IL-6,SOFA score and APACHE Ⅱ score between the two groups(P<0.05).Cox regression model showed that age,MR-proADM,mechanical ventilation,IL-6 and APACHE Ⅱ score were the risk factors of 28-day death in the low-isk group,while MR-proADM,Lac,SOFA score and APACHE Ⅱ score were the risk factors of 28 day mortality in the mium-ig-risk group.In each group,MR-proADM had a good predictive ability for the prognosis of patients with sepsis(P<0.001).Especially in low rik patients with sepsis,the predictive ability of MR-proADM was better than other indicators.Kaplan-Meier survival curve suggested that the patients with MR-proADM>2.53 nmol/L had worse prognosis than those with MR-proADM S2.53 nmol/L,and the differenee was stistically significant(P<0.001).In the low risk group,the morality of patients inereased from 7.8%to 58.2% if MR proADM>2.53 nmol/L.Conclusions MR-proADM is a risk factor for 28 day mortality in patients with sepsis,and MR-proADM can early identify the poor prognosis of low-risk paticnts wit sepsis.
作者
王娜
商娜
李俊玉
刘慧珍
王雅慧
席修明
Wang Na;Shang Na;Li Junyu;Liu Huizhen;Wang Yahui;Xi Xiuming(School of Rehabilitation Medicine,Capital Medical University,Beijing 100068,China;Department of Emergency,Beijing Boai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Critical Care Medicine,Fu Xing Hospital,Capital Medical Universiy Beijing 100038,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2022年第9期1210-1215,共6页
Chinese Journal of Emergency Medicine
基金
国家科技支撑计划(2012BAI11B05)
北京市丰台区卫计委课题(2018-71)。
关键词
肾上腺髓质中段肽
低风险
早期识别
脓毒症
预后
Mid-regional proadrenomedullin
Low risk
Early recognition
Sepsis
Prognosis
