摘要
目的:探讨急性胃肠损伤(AGI)分级联合序贯器官衰竭评分(SOFA)对脓毒症患者28 d预后的预测价值。方法:以192例脓毒症患者为研究对象,根据患者28 d是否存活分为存活组和死亡组,比较2组的临床特征。入院1周内每日记录AGI分级,并分析不同AGI分级患者的临床特征。分别绘制AGI分级、SOFA评分、急性生理学及慢性健康状况(APACHEⅡ)评分以及AGI分级联合SOFA评分对患者28 d预后的受试者工作特征(ROC)曲线,计算相应的曲线下面积(AUC),并进行比较。结果:192例脓毒症患者28 d死亡率为38.0%(73/192),AGI的发生率为89.1%(171/192),其中1级患者69例,2级72例,3级26例,4级4例。AGI分级越高,患者危重症评分、28 d死亡率越高(P均<0.01)。多元回归分析显示,年龄、乳酸、机械通气(MV)、AGI分级以及APACHEⅡ评分是脓毒症患者28 d死亡的独立危险因素(P均<0.05)。ROC曲线分析提示,AGI分级、SOFA评分对患者28 d死亡的预测能力均低于APACHEⅡ评分,但两者相结合的预测能力与APACHEⅡ评分相当(P>0.01)。结论:脓毒症患者AGI发生率高,AGI分级联合SOFA评分对脓毒症患者28 d预后有预测价值。
Objective:To evaluate the predictive value of the acute gastrointestinal injury(AGI) grade and the sequential organ failure assessment(SOFA) score in the 28-day prognosis of patients with sepsis.Methods:A total of 192 patients with sepsis admitted to emergency intensive care unit(EICU) were selected as the study objects.They were divided into survival group and death group according to 28-day survival,and the clinical characteristics of the two groups were compared.The AGI grade was recorded daily within one week after admission,and the clinical characteristics of patients with different AGI grades were analyzed.The receiver operating characteristic(ROC) curves of AGI grade,SOFA score,the acute physiology and chronic health evaluation II(APACHE II) score and AGI grade combined with SOFA score on the 28-day prognosis of patients were drawn respectively,and the corresponding area under curve(AUC) was calculated and compared.Results:Totally,192 patients with sepsis were included.The 28-day mortality was 38.0%(73/192),and the incidence of AGI was 89.1%(171/192).There were 69 patients with grade 1,72 patients with grade 2,26 patients with grade 3 and 4 patients with grade 4.With the increase of AGI grade,the critical illness scores increased,and the 28-day mortality increased significantly.Multiple regression analysis showed that age,lactic acid,mechanical ventilation(MV),AGI grade and APACHE II score were independent risk factors for 28-day mortality in patients with sepsis.The ROC curve analysis showed that the predictive ability of AGI grade or SOFA score on 28-day mortality was lower than APACHE II score,but their combined predictive ability was not significantly different from APACHE II score.Conclusion:AGI is common in patients with sepsis in emergency department.The predictive ability of AGI grade combined with SOFA score on 28-day mortality is valuable in patients with sepsis.
作者
王娜
王丰容
李俊玉
商娜
刘慧珍
刘小蒙
席修明
WANG Na;WANG Feng-rong;LI Jun-yu;SHANG Na;LIU Hui-zhen;LIU Xiao-meng;XI Xiu-ming(Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Emergency Department of Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Critical Care Medicine,Fu Xing Hospital,Capital Medical University,Beijing 100068,China)
出处
《内科急危重症杂志》
2024年第1期12-16,共5页
Journal of Critical Care In Internal 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
急性胃肠损伤分级
序贯器官衰竭评分
脓毒症
预后
Acute gastrointestinal injury
Sequential organ failure assessment
Sepsis
Adverse prognosis
