Evaluation value of early sequential organ failure score changes after admission for short-term prognosis of elderly sepsis
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摘要: 目的 探讨入院后早期序贯器官衰竭评分(sequential organ failure assessment，SOFA)变化(ΔSOFA)对老年脓毒症短期预后的评估价值。方法 回顾性分析我院急诊重症监护病房(EICU)2016年1月—2019年12月收治的90例老年脓毒症患者的临床资料，根据28 d生存状况，分成生存组和死亡组，收集并分析一般资料和相关实验室指标。采用logistic回归分析筛选老年脓毒症患者28 d内死亡的危险因素；绘制受试者工作特征(ROC)曲线，探讨48 h-ΔSOFA对老年脓毒症28 d预后的评估价值。结果 90例老年脓毒症患者中，28 d内死亡47例，生存43例。单因素分析显示，死亡组入院即刻SOFA、48 h-ΔSOFA、血降钙素原和乳酸水平高于生存组，血清Ca2+水平低于生存组，差异均有统计学意义(均P < 0.05)。多因素二元logistic回顾分析显示，48 h-ΔSOFA是老年脓毒症28 d死亡的独立危险因素(OR=2.383，95%CI：1.535~3.702，P < 0.01)；应用绘制ROC曲线分析显示，入院48 h-ΔSOFA预测老年脓毒症患者28 d预后的曲线下面积为0.900(95%CI：0.834~0.967，P < 0.01)。结论 48 h-ΔSOFA在入院早期评估老年脓毒症病情严重程度及短期预后方面具有良好、可靠的预测价值。Abstract: Objective To explore the value of early changes in sequential organ failure assessment(SOFA) after admission(ΔSOFA) in evaluating the short-term prognosis of elderly sepsis.Methods A retrospective analysis was conducted on the clinical data of 90 elderly sepsis patients admitted to the emergency intensive care unit(EICU) of our hospital from January 2016 to December 2019. Based on their 28 day survival status, they were divided into a survival group and a death group. General information and relevant laboratory indicators were collected and analyzed. Using logistic regression analysis to screen risk factors for mortality within 28 days in elderly sepsis patients; Draw receiver operating characteristic(ROC) curves to explore the evaluation value of 48 h-ΔSOFA in the 28 day prognosis of elderly sepsis.Results Among 90 elderly sepsis patients, 47 cases died within 28 days and 43 cases survived. Univariate analysis showed that the levels of SOFA, 48 h-ΔSOFA, procalcitonin and lactate in the death group were higher than those in the survival group upon admission, while the serum Ca2+ level was lower than that in the survival group, and the differences were statistically significant(all P < 0.05). Multivariate binary logistic review analysis showed that 48 h-ΔSOFA was an independent risk factor for 28 day mortality in elderly sepsis(OR=2.383, 95%CI: 1.535-3.702, P < 0.01). The application of ROC curve analysis showed that the area under the curve for predicting the 28 day prognosis of elderly sepsis patients with 48 h-ΔSOFA after admission was 0.900(95%CI: 0.834-0.967, P < 0.01).Conclusion 48 h-ΔSOFA has good and reliable predictive value in evaluating the severity and short-term prognosis of elderly sepsis in the early stage of admission.
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Key words:
- sepsis /
- elderly /
- prognosis /
- sequential organ failure assessment
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表 1 受试者一般情况和临床特征比较
M(P25，P75)，X±S 项目 总数(90例) 生存(43例) 死亡(47例) χ2/t/Z P 年龄/岁 82.9±7.3 81.3±8.0 84.3±6.3 1.930 0.058 性别/例(%) 0.040 0.844 男 64(71.1) 31(48.4) 33(51.6) 女 26(28.9) 12(46.2) 14(53.8) 体温/℃ 36.7(36.5~37.0) 36.7(36.5~37.2) 36.6(36.4~36.9) -0.552 0.581 平均动脉压/mmHg 103.6±17.2 100.7±14.1 89.9±17.2 2.490 0.118 心率/(次/min) 88.0(78.0，95.3) 87.0(78.0，95.0) 90.0(77.0，97.0) -0.480 0.470 呼吸频率/(次/min) 18.0(18.0，20.0) 18.0(18.0，20.0) 19.0(18.0，20.0) -0.920 0.358 高血压/例(%) 0.700 0.404 是 44(48.9) 23(52.3) 21(47.7) 否 46(51.1) 20(43.5) 26(56.5) 糖尿病/例(%) 0.270 0.605 是 29(32.2) 15(51.7) 14(48.3) 否 61(67.8) 28(45.9) 33(54.1) 呼吸系统疾病/例(%) 2.780 0.095 是 24(26.7) 8(33.3) 16(66.7) 否 66(73.3) 35(53.0) 31(47.0) 心血管系统疾病/例(%) 0.840 0.360 是 65(48.2) 33(50.8) 32(49.2) 否 25(27.8) 10(40.0) 15(60.0) 神经系统疾病/例(%) 0.700 0.402 是 29(32.2) 12(41.4) 17(58.6) 否 61(67.8) 31(50.8) 30(49.2) PCT/(ng/mL) 0.14(0.09，0.23) 0.1(0.07，0.13) 0.26(0.13，0.44) 5.650 < 0.001 Lac/(mmol/L) 1.98(1.25，2.70) 1.39(1.02，2.00) 2.6(1.60，3.50) 4.699 < 0.001 Ca2+/(mmol/L) 2.07(1.98，2.15) 2.15(1.99，2.18) 2.03(1.93，2.10) -3.84 < 0.001 即刻SOFA/分 3.00(2.00，3.25) 2.00(2.00，3.00) 3.00(2.00，4.00) 2.552 0.011 48 h-ΔSOFA 0.50(-1.00，2.25) -1.00(-2.00，0) 2.00(1.00，4.00) 6.596 < 0.001 注：1 mmHg=0.133 kPa。 
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表 2 预测老年脓毒症短期预后的logistic回归模型
项目 β OR P 95%CI 48 h-ΔSOFA 0.869 2.383 < 0.001 1.535~3.702 PCT 9.782 17.709 0.004 2.400~127.478 Lac 1.178 3.249 0.009 1.334~7.914
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表 3 研究指标的AUC和界值
项目 AUC cut-off值 灵敏度 特异度 约登指数 PCT 0.846 0.160 ng/mL 0.702 0.860 0.562 Lac 0.787 2.400 mmol/L 0.570 0.930 0.504 48 h-ΔSOFA 0.900 0.500 0.830 0.860 0.690 三者联合 0.953 0.393 0.957 0.884 0.841
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