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摘要: 目的 探讨ROX-HR指数对于脓毒症患者28 d死亡率的预测价值。方法 选取我院2022年10月—2023年10月收治的178例脓毒症患者和79例脓毒性休克患者，进行回顾性研究。通过入院后2 h内所记录的呼吸、心率、氧饱和度、吸入氧浓度计算ROX-HR指数及ROX指数。记录2 h内最差的ROX-HR指数及ROX指数。采用logistic回归模型确定与脓毒症28 d死亡率相关的独立预测因素。采用受试者工作特征(receiver operator characteristic，ROC)曲线评价ROX-HR指数对脓毒症患者的预测价值。用约登指数确定ROX-HR指数对脓毒症患者死亡率的预测价值。根据约登指数确定的ROX-HR指数最佳截点值(6.3)，将所有脓毒症患者分为高ROX-HR指数组(ROX-HR指数≥6.3)和低ROX-HR指数组(ROX-HR指数＜6.3)，绘制Kaplan-Meier生存曲线分析ROX-HR指数与两组患者生存状态的关系。结果 通过logistic回归分析提示更高的APACHE Ⅱ评分、乳酸及更低的ROX-HR指数与脓毒症患者的28 d死亡率发生独立相关。通过ROC的结果得出，ROX-HR指数、APACHE Ⅱ评分、乳酸和ROX指数的ROC曲线下面积(area under curve，AUC)分别为0.722(95%CI：0.641~0.802)、0.758(95%CI：0.685~0.830)、0.674(95%CI：0.585~0.762)和0.684(95%CI: 0.600~0.768)。通过Kaplan-Meier生存曲线分析显示，高ROX-HR指数组累计生存率明显高于低ROX-HR指数组(79.37% vs 34.62%，P＜0.01)。ROX-HR指数与脓毒性休克患者的28 d死亡率的AUC为0.607。结论 ROX-HR指数在死亡组中明显低于存活组，ROX-HR指数＜6.3是脓毒症患者28 d死亡风险的独立预测因素。ROX-HR指数对于脓毒性休克患者的预测能力较差。Abstract: Objective To investigate the predictive value of the ROX-HR index for 28-day mortality in sepsis patients.Methods A total of 178 patients with sepsis admitted to our hospital from October 2022 to October 2023 were selected for this retrospective study. ROX-HR index and ROX index were calculated from respiration, heart rate, oxygen saturation, and inspired oxygen concentration recorded within 2 hours after admission. The worst ROX-HR index and ROX index within 2 hours were recorded. Logistic regression modeling was used to determine the independent predictors associated with 28-day mortality in sepsis patients. The predictive value of the ROX-HR index for sepsis patients was evaluated using the Receiver operator characteristic(ROC) curve. The predictive value of ROX-HR index for mortality in sepsis patients was determined using the Youden index. Based on the optimal cut-off value of ROX-HR index determined by the Youden index, all sepsis patients were divided into the high ROX-HR index group and the low ROX-HR index, and the Kaplan-Meier survival curves were plotted to analyze the relationship between ROX-HR index and the survival status of the two groups of patients.Results Higher APACHE Ⅱ score, higher lactate and lower ROX-HR index were suggested to be independently associated with the 28-day mortality in sepsis patients by logistic regression analysis. The results of area under curve(AUC) of ROX-HR index, APACHE Ⅱ, lactate and ROX index were 0.722(95%CI: 0.641-0.802)、0.758(95%CI: 0.685-0.830)、0.674(95%CI: 0.585-0.762) and 0.684(95%CI: 0.600-0.768), respectively. Patients were categorized into high and low ROX-HR groups based on the best cut-off value(6.3) of ROX-HR for predicting 28-day mortality in sepsis patients, and analysis of the Kaplan-Meier curves showed that the cumulative survival rate in the high ROX-HR index group was significantly higher than that in the low ROX-HR index group(79.37% vs 34.62%, P < 0.01). The AUC of ROX-HR index for patients with septic shock was 0.607.Conclusion ROX-HR index was significantly lower in the death group than in the survival group, and ROX-HR index < 6.3 was an independent predictor of 28-day mortality in sepsis patients. The ROX-HR index has poor predictive value in patients with septic shock.
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Key words:
- sepsis /
- ROX index /
- ROX-HR index
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表 1 生存组和死亡组患者基线资料比较
变量 生存组(118例) 死亡组(60例) P 年龄/岁 66.0(56.0~73.0) 69.0(60.0~76.0) 0.182 性别/例(%) 0.684 男 70(59.32) 38(62.29) 女 48(40.68) 22(37.71) 基础疾病/例(%) 高血压 34(28.81) 21(35.00) 0.401 糖尿病 37(31.36) 26(43.33) 0.116 慢性肾疾病 16(13.56) 9(15.00) 0.796 冠心病 11(9.32) 5(8.33) 0.747 脑卒中 4(3.39) 2(3.33) 0.830 COPD 3(2.54) 2(3.33) 0.768 其他 39(33.05) 16(26.67) 0.386 感染部位/例(%) 肺部感染 46(38.98) 31(51.67) 0.108 腹腔感染 23(19.49) 14(23.33) 0.553 泌尿系统感染 42(35.59) 13(21.67) 0.031 皮肤软组织感染 6(5.08) 8(14.81) 0.054 其他 9(7.63) 1(1.67) 0.104 APACHE Ⅱ评分/分 15.0(10.0~22.0) 25.0(18.0~30.0) ＜0.001 SOFA评分/分 8.0(4.0~11.0) 12.0(9.0~15.0) ＜0.001 GCS评分/分 15.0(9.0~15.0) 8.0(3.0~9.0) ＜0.001 IL-6/(pg·mL-1) 165.6(47.6~1177.6) 3296.2(283.4~13765.6) ＜0.001 IL-10/(pg·mL-1) 11.0(4.8~91.6) 206.6(24.6~979.4) ＜0.001 乳酸/(mmol·L-1) 2.3(1.5~3.7) 3.6(2.1~8.8) ＜0.001 呼吸频率/(次·min-1) 20.0(17.0~25.0) 25.0(18.0~32.0) 0.030 心率/(次·min-1) 88.0(76.0~100.0) 106.0(90.0~133.0) ＜0.001 吸入氧浓度/% 41.0(41.0~50.0) 50.0(41.0~60.0) 0.017 ROX指数 11.89(7.90~14.17) 6.31(4.66~11.07) ＜0.001 ROX-HR指数 13.27(8.84~18.49) 5.37(3.99~10.98) ＜0.001 
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表 2 单因素logistic回归分析
变量 OR 95%CI P 年龄 0.991 0.961~1.021 0.189 APACHE Ⅱ 1.120 1.076~1.172 ＜0.001 SOFA 1.202 1.118~1.303 ＜0.001 GCS 0.754 0.687~0.820 ＜0.001 IL-6 1.000 1.000~1.000 0.001 IL-10 1.000 1.000~1.000 0.103 乳酸 1.250 1.136~1.392 ＜0.001 ROX指数 0.848 0.781~0.914 ＜0.001 ROX-HR指数 0.842 0.786~0.896 ＜0.001
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表 3 根据ROX-HR指数的截断点分组后的患者基线特征
变量 高ROX-HR指数组(126例) 低ROX-HR指数组(52例) P 年龄/岁 66.0(55.0~73.0) 69.0(60.0~76.0) 0.182 男性/例(%) 70(59.32) 38(62.29) 0.185 基础疾病/例(%) 高血压 39(30.95) 16(30.77) 0.982 糖尿病 44(34.92) 19(36.54) 0.839 慢性肾疾病 20(15.87) 5(9.62) 0.278 冠心病 11(9.32) 5(9.62) 0.854 脑卒中 4(3.39) 2(3.85) 0.826 COPD 1(0.79) 4(7.69) 0.012 其他 40(31.75) 15(28.85) 0.706 感染部位/例(%) 肺部感染 48(38.10) 29(55.77) 0.031 腹腔感染 27(21.43) 10(19.23) 0.749 泌尿系统感染 45(35.71) 10(19.23) 0.031 皮肤软组织感染 8(6.35) 6(11.54) 0.244 其他 10(7.94) 2(3.85) 0.513 APACHE Ⅱ评分/分 17.0(11.0~23.0) 23.0(15.0~29.0) ＜0.001 SOFA评分/分 9.0(4.0~12.0) 12.0(8.0~14.0) ＜0.001 GCS评分/分 15.0(9.0~15.0) 8.0(3.0~10.0) ＜0.001 IL-6/(pg/mL) 267.3(58.7~4926.3) 1004.9(161.5~14630.1) ＜0.001 IL-10/(pg/mL) 18.3(6.6~218.8) 56.7(6.6~1045.5) ＜0.001 乳酸/(mmol/L) 2.4(1.5~3.9) 3.4(1.9~8.1) ＜0.001 呼吸频率/(次/min) 18.0(16.0~22.0) 32.0(28.0~34.0) ＜0.001 心率/(次/min) 87.0(76.0~96.0) 120.0(103.0~140.0) ＜0.001 吸入氧浓度/% 41.0(41.0~41.0) 60.0(50.0~60.0) ＜0.001 ROX指数 12.41(9.15~14.20) 4.73(4.26~5.50) ＜0.001 ROX-HR指数 14.55(10.55~18.56) 4.12(3.70~4.83) ＜0.001
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