APACHE Ⅱ score combined with serum PCT, D-D, and LCR for the prediction of poor prognosis in sepsis
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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。Abstract: Objective: To investigate the predictive value of acute physiological and chronic health Ⅱ(APACHE Ⅱ) 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. APACHE Ⅱ scores, 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 APACHE Ⅱ scores 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 APACHE Ⅱ scores, 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 APACHE Ⅱ scores, 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 APACHE Ⅱ scores, 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 APACHE Ⅱ scores, serum PCT, D-D, and lower LCR. The combination of APACHE Ⅱscores, 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.
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[1] Kuttab HI,Lykins JD,Hughes MD,et al.Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock[J].Crit Care Med,2019,47(11):1582-1590.
[2] Kothiwale VA,Patil P,Gaur S.Correlation of Thyroid Hormone Profile with the Acute Physiology and Chronic Health Evaluation II Score as a Prognostic Marker in Patients with Sepsis in the Intensive Care Unit[J].J Assoc Physicians India,2018,66(7):59-62.
[3] 张志彪,严丽.PCT、LAC/ScvO2比值对脓毒症患者病情危重程度与预后的评估价值[J].临床急诊杂志,2019,20(2):119-123.
[4] 米俊,周荣赛.血清肝素结合蛋白水平联合入院24 h乳酸清除率对肺炎并发脓毒症患者预后的评估价值研究[J].临床急诊杂志.2020,21(1):91-95.
[5] Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J].JAMA,2016,315(8):801-810.
[6] 中国医师协会急诊医师分会,中国研究型医院学会休克与脓毒症专业委员会.中国脓毒症/脓毒性休克急诊治疗指南(2018)[J].临床急诊杂志,2018,19(9):567-588.
[7] Putzu A,Schorer R,Lopez-Delgado JC,et al.Blood Purification and Mortality in Sepsis and Septic Shock:A Systematic Review and Meta-analysis of Randomized Trials[J].Anesthesiology,2019,131(3):580-593.
[8] Shimizu K,Yamada T,Ogura H,et al.Synbiotics modulate gut microbiota and reduce enteritis and ventilator-associated pneumonia in patients with sepsis:a randomized controlled trial[J].Crit Care,2018,22(1):239.
[9] Gharebaghi N,Valizade Hasanloei MA,Medizadeh Khalifani A,et al.Neutrophil-to-lymphocyte ratio in patients with gram-negative sepsis admitted to intensive care unit[J].Anaesthesiol Intensive Ther,2019,51(1):11-16.
[10] Karon BS,Tolan NV,Wockenfus AM,et al.Evaluation of lactate,white blood cell count,neutrophil count,procalcitonin and immature granulocyte count as biomarkers for sepsis in emergency department patients[J].Clin Biochem,2017,50(16-17):956-958.
[11] 余长升,马艳红,辛晓婷.降钙素原、C反应蛋白清除率对脓毒性休克患者的预后价值[J].临床急诊杂志,2020,21(6):482-487.
[12] 江蓉,刘建华,徐内卫.血清S-ChE PAB Apo A1及APACHE Ⅱ评分对重症肺炎预后的评估[J].河北医学,2018,24(4):540-544.
[13] 唐晓霞,徐杰马,宇杰.CHE、Lac、Lcr联合检测对重症SAP患者预后预测价值的研究[J].临床急诊杂志,2020,21(3):217-221.
[14] 姚乐,赵浩,张洁,等.急性生理和慢性健康状况评分Ⅱ和序贯器官衰竭评估评分对急诊重症监护病房脓毒症患者的预后评估价值[J].中国临床医生杂志,2018,46(3):276-278.
[15] 乔增海,尚志博.乌司他丁对重症脓毒症患者血浆PCT、CRP水平的影响及对心肝肾的保护作用[J].河北医药,2018,40(8):1172-1174,1179.
[16] Liu GB,Cui XQ,Wang ZB,et al.Detection of serum procalcitonin and hypersensitive C-reactive protein in patients with pneumonia and sepsis[J].J Biol Regul Homeost Agents,2018,32(5):1165-1169.
[17] Innocenti F,Gori AM,Giusti B,et al.Prognostic value of sepsis-induced coagulation abnormalities:an early assessment in the emergency department[J].Intern Emerg Med,2019,14(3):459-466.
[18] 钟娩玲,黄宇戈.早期乳酸测定联合儿童危重病例评分在重症监护室脓毒症患儿预后评估中的作用[J].中华实用儿科临床杂志,2019,34(12):934-937.
[19] 高守君,吴艺,高敏,等.血乳酸和乳酸清除率对严重脓毒症患者预后的评估价值[J].海南医学,2018,29(12):1642-1644.
[20] Wirz Y,Meier MA,Bouadma L,et al.Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients:a patient-level meta-analysis of randomized trials[J].Crit Care,2018,22(1):191.
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