摘要
目的探讨血液净化治疗启动时机及滤器选择对脓毒症患者短期预后的影响。方法回顾性收集新疆医科大学第一附属医院收治的接受血液净化治疗的脓毒症患者。收集其启动当天的相关指标进行单因素分析,用ROC曲线对比各指标的预测效果,确定最佳临界值并用其分组,分析使用AN69/oXiris在各界值上/下组中28天死亡率的情况。结果共纳入66例患者,入院28天内死亡31例。单因素分析显示年龄校正查尔森合并症指数(age-adjusted Charlson comorbidity index,aCCI)、英国国家早期预警评分(national early warning score,NEWS)、脓毒症相关性器官衰竭评价(sequential ogran failure assessment,SOFA)、急性生理学和慢性健康评估Ⅱ(acute physiology and chronic health evaluation system,APACHEⅡ)(OR值依次为1.380、1.213、1.141、1.079,95%CI:依次为1.035~1.838、1.062~1.386、1.005~1.297、1.017~1.144,P值依次为0.028、0.005、0.042、0.012)是28天内死亡的危险因素;肌酐(Scr)(OR=0.994,95%CI:0.991~0.998,P=0.001)是28天内死亡的保护因素;aCCI、NEWS、SOFA、APACHEⅡ、Scr的AUC分别为0.674、0.698、0.657、0.679、0.736,95%CI:分别为0.543~0.806、0.572~0.824、0.521~0.793、0.548~0.811、0.614~0.858,最佳界值分别为3.5分、14.5分、11.5分、19.5分、418.98μmol/L。低aCCI组使用oXiris治疗的患者,28天死亡率更低(χ^(2)=4.572,P=0.032)。结论血液净化治疗启动时脓毒症患者的aCCI在3.5分以上、NEWS在14.5分以上、SOFA在11.5分以上、APACHEⅡ在19.5分以上、Scr在418.98μmol/L以下28天内死亡风险越高。脓毒症患者在aCCI较低时,选用oXiris治疗与AN69膜材相比,可降低脓毒症患者28天死亡率。
Purpose To investigate the effect of start time of blood purification and the selection of filter on short-term prognosis of the patients with sepsis.Methods We retrospectively recruited the sepsis patients treated with blood purification in the First Affiliated Hospital of Xinjiang Medical University.Their clinical indices at the day of starting blood purification were collected and analyzed using univariate regression method.ROC curve was used to compare the prediction effect of these indices and to determine their optimal values for dividing the patients in groups.The 28-day mortality rate was evaluated in the patients using the AN69/oXiris filter and in the patient groups with the highest and lowest cutoff values of the indices.P<0.05 was considered to be statistically significant.Results A total of 66 patients were included in this study,in which 31 died within 28 days of hospitalization.Univariate analysis showed that age-adjusted Charlson comorbidity index(aCCI),national early warning score(NEWS),sequential organ failure assessment(SOFA),and acute physiology and chronic health evaluation II(APACHE II)were the risk factors for mortality within 28 days(OR=1.380,1.213,1.141 and 1.079 respectively;95%CI:1.035~1.838,1.062~1.386,1.005~1.297 and 1.017~1.144 respectively;P=0.028,0.005,0.042 and 0.012 respectively);Scr was the protective factor for mortality within 28 days(OR=0.994,95%CI:0.991~0.998,P=0.001).The optimal cut-off values of aCCI,NEWS,SOFA,APACHE II and Scr were 3.5 scores,14.5 scores,11.5 scores,19.5 scores and 418.98μmol/L respectively;the areas under the curves of aCCI,NEWS,SOFA,APACHE II and Scr were 0.674,0.698,0.657,0.679 and 0.736 respectively(95%CI:0.543~0.806,0.572~0.824,0.521~0.793,0.548~0.811 and 0.614~0.858 respectively).The patients in the lower aCCI group and using the oXiris filter had a lower 28-day mortality rate(χ^(2)=4.572,P=0.032).Conclusion①Sepsis patients with the aCCI score>3.5,NEWS score>14.5,SOFA score>11.5,APACHE II score>19.5,and Scr<418.98μmol/L at the start of blood purification had a higher risk of mortality within 28 days;②in sepsis patients with lower aCCI,the 28-day mortality was lower in those using the oXiris filter than in those using the AN69 filter for blood purification.
作者
陈希
万宏哲
吴硕
张丽
CHEN Xi;WAN Hong-zhe;WU Shuo;ZHANG Li(Nephrology Center,the First Affiliated Hospital of Xinjiang Medical University,Xinjiang Clinical Research Center of Renal Replacement Therapy,Xinjiang Branch of National Clinical Research Center For Kidney Disease,Xinjiang Blood Purification Medical Quality Control Center,Institute of Nephrology of Xinjiang,Urumqi 830011,China;Department of Nephrology,Shenzhen Baoan District Songgang People’s Hospital,Shenzhen 518105,China)
出处
《中国血液净化》
CSCD
2023年第7期493-497,共5页
Chinese Journal of Blood Purification
基金
新疆维吾尔自治区自然科学基金重点项目(2022D01D61)
国家自然科学基金(81960145)
新疆维吾尔自治区研究生科研创新项目(XJ2022G173)。
