液体复苏前后外周灌注指数水平对脓毒性休克患者28d死亡风险预测价值的研究

任娜; 刘名胜; 周森

doi:10.13201/j.issn.1009-5918.2021.06.003

液体复苏前后外周灌注指数水平对脓毒性休克患者28d死亡风险预测价值的研究

- 海南医学院第二附属医院重症医学科(海口,570311)
基金项目:
海南省卫生健康行业科研项目(No:19A2000079)

详细信息

通讯作者: 周森,E-mail:icu2zs@163.com

中图分类号: R459.7

收稿日期: 2021-03-18

Predictive value of peripheral perfusion index before and after the treatment of liquid resuscitation for 28-day mortality in patients with septic shock

- Department of Intensive Care Unit, The Second Affiliated Hospital of Hainan Medical University, HaiKou, 570311, China

More Information

Corresponding author: ZHOU Sen, E-mail: icu2zs@163.com

Received Date: 18 March 2021

摘要

摘要: 目的:探讨液体复苏前后外周灌注指数(PPI)水平对脓毒性休克患者28 d死亡风险的预测价值。方法:选取2019年1月-2021年1月期间在我院重症监护病房(ICU)治疗的213例脓毒性休克患者为研究对象。根据28 d预后情况分为存活组(157例)和死亡组(56例)。单因素和多因素Logistic回归分析临床资料确定脓毒性休克患者死亡的影响因素。利用受试者工作特征曲线(ROC)评估液体复苏前后PPI水平对脓毒性休克患者28 d死亡风险的预测价值。Spearson相关性分析探讨液体复苏前后PPI水平与脓毒性休克患者脓毒症相关序贯器官衰竭估计(SOFA)评分之间的相关性。结果:脓毒性休克患者病死率为26.29%(56/213),平均年龄(52.26±18.18)岁,男128例(60.09%),女85例(39.91%)。多因素Logistic回归分析显示,年龄(OR=1.033,95%CI:1.006~1.061,P<0.001),SOFA评分(OR=1.153,95%CI:1.010~1.316,P=0.036)和复苏后6 h PPI(OR=0.508,95%CI:0.363~0.709,P<0.001)是脓毒性休克患者死亡的影响因素。复苏前PPI和复苏后6 h PPI水平与SOFA评分呈负相关(r_s分别为-0.309和-0.387,P<0.001)。ROC曲线分析结果显示,复苏后6 h PPI预测脓毒性休克患者28 d死亡的曲线下面积(AUC)明显大于复苏前PPI及SOFA评分(0.880 vs. 0.793,Z=2.270,P<0.05;0.880 vs. 0.758,Z=2.270,P<0.05)。当复苏后6 h PPI最佳截断值为2.06时,其诊断敏感度为82.14%,特异度为80.25%。结论:复苏后6 h PPI水平升高是脓毒性休克患者死亡的保护因素,对脓毒性休克患者的28 d死亡风险具有良好的预测价值。
- 脓毒性休克 /
- 外周灌注指数 /
- 预测价值 /
- 病死率
Abstract: Objective: To investigate the predictive value of peripheral perfusion index(PPI) before and after the treatment of liquid resuscitation for 28-day mortality in patients with septic shock.Methods: A prospective study was conducted on 213 patients with septic shock who were treated in Intensive Care Unit(ICU) of the Second Affiliated Hospital of Hainan Medical College from January 2019 to January 2021. According to the 28-day prognosis, the patients were divided into the survival group(n=157) and the non-survival group(n=56). Univariate and multivariate Logistic regression analysis were performed to identify the influencing factors of 28-day mortality in patients with septic shock. Receiver operating characteristic curve(ROC) was applied to analyze the predictive value of PPI level before and after the treatment of liquid resuscitation for 28-day mortality risk in patients with septic shock. the correlations between PPI level before and after the treatment of liquid resuscitation and Sepsis-related Organ Failure Assessment(SOFA) score in patients with septic shock were analyzed using Spearson correlation analysis.Results: Of the 213 patients included in the study, 128(60.09%) patients were males and 85(39.91%) were females with a mean age of(52.26±18.18)years. The total mortality in 28-day was 26.29%(56/213). Multivariate Logistic regression analysis showed that age(OR=1.033, 95%CI: 1.006-1.061, P<0.001), SOFA score(OR=1.153, 95%CI: 1.010-1.316, P=0.036) and PPI at 6 hour after resuscitation(OR=0.508, 95%CI: 0.363-0.709, P<0.001) were the influencing factors for death in patients with septic shock. PPI before resuscitation and PPI at 6 hours after resuscitation were negatively correlated with SOFA score(r_s=-0.309 and-0.387, respectively, P<0.001). ROC curve analysis showed that the area under the curve(AUC) of PPI at 6 h after resuscitation for predicting 28-day mortality risk in patients with septic shock was significantly larger than those of PPI before resuscitation and SOFA score(0.880 vs. 0.793, Z=2.270, P<0.05; 0.880 vs. 0.758, Z=2.270, P<0.05). The optimal cut-off value of PPI at 6 hours after resuscitation was 2.06, and the sensitivity and specificity were 82.14% and 80.25%, respectively.Conclusion: The increased PPI level at 6 hours after resuscitation was an independently protective factor for 28-day mortality in patients with septic shock, and had a good predictive value for 28-day mortality risk in patients with septic shock.
- septic shock /
- peripheral perfusion index /
- predictive value /
- mortality

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