摘要
目的探讨卡诺夫斯基健康状况量表评分(Karnofsky performance scores,KPS评分)对老年脓毒症患者预后的评估价值,为临床评估病情、判断预后及采取相应治疗措施提供依据。方法采用回顾性队列研究方法,收集2018年1月至2021年6月在本院重症医学科住院的老年脓毒症患者的一般情况资料、入院最初24 h临床资料和入院前肢体运动功能状态和自理能力的随访资料。根据患者是否于住院期间存活将其分为存活组和死亡组。采用t检验、χ^(2)检验、Mann-Whitney检验,比较两组患者入院前反映患者肢体运动功能状态和自理能力的KPS评分、入院时病情危重程度评分[急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官功能衰竭评分(sepsis-related organ failure assessment,SOFA)]、血清降钙素原(procalcitonin,PCT)、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NTproBNP)、动脉血乳酸水平等指标的差异;其后将单因素分析有统计学意义的因素进行Logistic回归方法分析,确定其中预测住院期间病死率的独立危险因素,并绘制受试者工作特征曲线(receiver operating characteristic,ROC),评估KPS评分对老年脓毒症患者预后的预测价值。结果共收集到符合标准的患者135例。其中男性85例,女性50例,住院期间死亡60例,存活75例,病死率为44.4%。死亡组老年脓毒症患者入院前KPS评分与存活组相比明显更低,分别为[30(30,40)vs.70(50,90),P<0.001]。多因素Logistic回归分析发现,KPS评分(OR=0.938,95%CI:0.914~0.963,P<0.001)、SOFA评分(OR=1.255,95%CI:1.086~1.451,P=0.002)和动脉血乳酸(OR=1.219,95%CI:1.059~1.404,P=0.006)为预测住院期间预后的独立危险因素。病死率ROC曲线分析显示,与SOFA评分和血乳酸相比,KPS评分的曲线下面积最大,AUC为0.830(95%CI:0.756~0.890,P<0.001);且KPS与SOFA和血乳酸联合对老年脓毒症预后的预测价值较单独指标更大,AUC达0.883(95%CI:0.826~0.940,P<0.001)。结论老年脓毒症患者的KPS评分越低预后越差,KPS评分可作为预测老年脓毒症患者预后的临床指标。
Objective To evaluate the prognostic value of Karnofsky performance scores(KPS)in elderly patients with sepsis,so as provide a basis for clinical evaluation of the condition,prognosis and corresponding treatment measures.Methods A retrospective cohort study was conducted to collect the general information,clinical data,and follow-up data of limb motor function status and self-care ability of elderly patients with sepsis who were hospitalized in the Intensive Care Unit of our hospital from January 2018 to June 2021.Patients were divided into the survival group and death group according to whether they survived the hospitalization.Statistical analysis was performed using t-test,chi-square test,and Mann-Whitney test.The KPS score before admission,disease severity scores(APACHEⅡand SOFA),serum procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-proBNP),and arterial blood lactate level on admission were compared between the two groups.Then,the factors with significance in univariate analysis were analyzed by Logistic regression method,the independent risk factors for predicting inhospital mortality were determined,and the receiver operating characteristic(ROC)curve was drawn to evaluate the prognostic value of KPS score in elderly patients with sepsis.Results A total of 135 patients were collected.There were 85 males and 50 females,60 died and 75 survived during hospitalization,with a mortality rate of 44.4%.The preadmission KPS score of elderly patients with sepsis in the death group was significantly lower than that in the survival group[30(30,40)vs.70(50,90),P<0.001].Multivariate logistic regression analysis showed that KPS score(OR=0.938,95%CI:0.914-0.963,P<0.001),SOFA score(OR=1.255,95%CI:1.066-1.451,P=0.002)and arterial blood lactate(OR=1.219,95%CI:1.059-1.404,P=0.006)were independent risk factors for predicting the prognosis during hospitalization.ROC curve analysis of mortality showed that compared with SOFA score and blood lactate,the area under the curve of KPS score was the largest,with AUC of 0.830(95%CI:0.756-0.890,P<0.001).In addition,the combination of KPS,SOFA and blood lactate had a greater predictive value for the prognosis of elderly patients with sepsis than that of the single index,with an AUC of 0.883(95%CI:0.826-0.940,P<0.001).Conclusions The lower the KPS score,the worse the prognosis of elderly patients with sepsis.The KPS score can be used as a clinical indicator to predict the prognosis of elderly patients with sepsis.
作者
李小舟
邱泽亮
赵广阔
邓星奇
Li Xiaozhou;Qiu Zeliang;Zhao Guangkuo;Deng Xingqi(Department of Emergency&Critical Care,Zhoupu Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2022年第11期1451-1456,共6页
Chinese Journal of Emergency Medicine
基金
上海市浦东新区卫生系统学科带头人人才培训计划(PWRD2016-08)
上海市浦东新区科委面上项目(PKJ2019-Y26)。
