|本期目录/Table of Contents|

[1]傅元冬,许飚,杨佩,等.PCT清除率联合前白蛋白评估老年脓毒症患者的预后价值[J].医学研究与战创伤救治(原医学研究生学报),2023,25(2):129-134.[doi:10.3969/j.issn.1672-271X.2023.02.004]
　FU Yuandong,XU Biao,YANG Pei,et al.Prognostic value of PCT clearance combined with prealbumin in elderly patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2023,25(2):129-134.[doi:10.3969/j.issn.1672-271X.2023.02.004]
点击复制

PCT清除率联合前白蛋白评估老年脓毒症患者的预后价值()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第25卷
期数:
2023年2期
页码:
129-134
栏目:
临床研究
出版日期:
2023-05-31

文章信息/Info

Title:
Prognostic value of PCT clearance combined with prealbumin in elderly patients with sepsis
作者:
傅元冬; 许飚; 杨佩; 周媛媛
作者单位：210000南京，南京中医药大学附属南京中医院重症医学科（傅元冬、许飚、杨佩、周媛媛）
Author(s):
FU Yuandong;  XU Biao;  YANG Pei; ZHOU Yuanyuan
（Department of Intensive Care Unit, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu,China）
关键词:
脓毒症; PCT清除率; 前白蛋白; 多器官功能障碍; 预后
Keywords:
sepsis; PCT clearance rate; prealbumin; multiple organ dysfunction; prognosis
分类号:
R459.7
DOI:
10.3969/j.issn.1672-271X.2023.02.004
文献标志码:
A
摘要:
目的探讨降钙素原（PCT）清除率、前白蛋白在老年脓毒症患者疾病严重程度和预后中的评估价值。方法回顾性分析2020年1月至2022年1月南京市中医院重症医学科收治的老年脓毒症患者的临床资料。根据器官功能障碍程度分为单器官功能障碍组及多器官功能障碍组，根据患者是否院内死亡分为生存组及死亡组，分别比较2组患者相关血清指标，探讨相关血清指标与器官功能障碍程度及预后的相关性；Logistic回归分析发生多器官功能障碍及院内死亡的危险因素；绘制受试者工作特征曲线（ROC），评估上述指标对院内死亡的预测效能。结果最终纳入103例老年脓毒症患者，与单器官功能障碍组比较，多器官功能障碍组急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、C反应蛋白(CRP)、PCT、白介素-6（IL-6）、血小板计数(PLT)、乳酸（Lac）水平显著升高（P<0.05）；Logistic多因素回归结果提示，并发血流感染（OR=42.79，95%CI：2.158~848.7）、APACHE Ⅱ评分（OR=1.123，95%CI：1.024~1.232）为发生多器官功能障碍的危险因素。与生存组比较，死亡组PCT、IL-6、Lac、APACHE Ⅱ评分、序贯器官衰竭评分(SOFA)明显高于生存组，PLT、第3天PCT清除率(PCTc3)、第7天PCT清除率(PCTc7)、前白蛋白明显低于生存组（P<0.05）；Logistic回归分析发现，SOFA评分（OR=1.349，95%CI：1.071~1.700）是老年脓毒症患者院内死亡的危险因素，PCTc7（OR=0.535，95%CI：0.320~0.894）、前白蛋白（OR=0.984，95%CI：0.971~0.998）为老年脓毒症患者院内死亡的保护因素（P<0.05）；ROC曲线分析以PCTc7、前白蛋白和SOFA评分为预测变量，预测院内死亡的ROC曲线下面积（AUC）分别为0.697（95%CI：0.588~0.805，P=0.001）、0.644（95%CI：0.531~0.757，P=0.015）和0.748（95%CI：0.646~0.850，P=0.000），而在SOFA评分基础上联合前白蛋白及PCTc7预测院内死亡价值最大（AUC=0.877，95%CI：0.804~0.951，P=0.000）。结论合并血流感染是老年脓毒症发生多器官功能障碍的危险因素，在SOFA评分基础上联合PCTc7、前白蛋白指标可显著提升对老年脓毒症院内死亡风险的预测，可作为临床预后判断的良好指标。
Abstract:
ObjectiveTo explore the evaluation value of PCT clearance, prealbumin on the severity and prognosis of elderly patients with sepsis.MethodsElderly patients with sepsis from Nanjing Hospital of Chinese Medicine in January 2020 to January 2022 were included. According to the degree of organ dysfunction, elderly patients were divided into single organ dysfunction group and multiple organ dysfunction group.And elderly patients were divided into survival group and death group according to prognosis in hospital. The differences in various indicators oftwo groups were compared. Logistic stepwise regression was used to screen out the risk factors of multiple organ dysfunction and mortality in hospital. Receiver operating characteristic curve (ROC) was drawn to evaluate the predictive efficacy of related indicators for in-hospital mortality.Results103 elderly patients with sepsis were enrolled.Compared with the single organ dysfunction group, APACHE Ⅱ score, CRP, PCT, IL-6, PLT and Lac level of multiple organ dysfunction group were increased significantly (P<0.05).Logistic stepwise regression showed that bloodstream infection（OR=42.79，95%CI：2.158-848.7） and APACHE Ⅱ score（OR=1.123，95%CI：1.024-1.232）were risk factors of multiple organ dysfunction.Compared with the survival group，APACHE Ⅱ score, SOFA score, PCT, IL-6 and Lac level of death group wereincreased significantly, while PLT, PCTc3, PCTc7 and prealbumin level decreased significantly(P<0.05). Logistic stepwise regression showed thatSOFA score（OR=1.349，95%CI：1.071-1.700）was a risk factor for in-hospital mortality in elderly patients with sepsis, while PCTc7（OR=0.535，95%CI：0.320-0.894） and prealbumin（OR=0.984，95%CI：0.971-0.998） were protective factors (P<0.05).ROC curve analysis showed thatPCTc7, prealbuminand SOFA could predict the prognosis of elderly sepsis patients, the area under ROC curve (AUC) were0.697（95%CI：0.588-0.805，P=0.001）, 0.644（95%CI：0.531-0.757，P=0.015） and 0.748 （95%CI：0.646-0.850，P=0.000）, the combination of prealbumin and PCTc7 on the basis of SOFA score had the greatest value (AUC=0.877，95%CI：0.804-0.951，P=0.000).ConclusionBloodstream infection is an independent risk factor for multiple organ dysfunction in elderly patients with sepsis. The combination of PCTc7 and prealbumin on the basis of SOFA score can significantly improve the prediction of the risk of hospital death in senile sepsis, and can be used as good indicators for clinical prognosis.

参考文献/References:

[1]Seymour CW, Liu VX, Iwashyna TJ, et al．Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock(sepsis-3)[J]．JAMA, 2016, 315 (8):762-774.
[2]Yang XJ,Jin J,Xu H,et al. Prognostic significance of serum procalcitonin in patients with extremely severe burn and sepsis[J]. Chin J Burns,2016,32(3):147-151.
[3]Gabriel W,Jessica B,Matthew C,et al.Demystifying Lactate in the Emergency Department[J].Ann Emerg Med,2020,75(2):287-298.
[4]Rhodes A,Evans LE,Alhazzani W,et al.Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016[J].Intensive Care Med, 2017,43(3):304-377.
[5]Morkar DN,Dwivedi M,Patil P.Comparative Study of Sofa, Apache Ⅱ, Saps Ⅱ, as a Predictor of Mortality in Patients of Sepsis Admitted in Medical ICU[J].J Assoc Physicians India,2022,70(4):11-12.
[6]Basile-Filho A, Lago AF, Menegueti MG, et al. The use ofAPACHE Ⅱ, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients: A retrospective cohort study[J].Medicine (Baltimore),2019, 98(26):e16204.
[7]SunGD, Zhang Y, Mo SS, et al. Multiple Organ Dysfunction Syndrome Caused by Sepsis: Risk Factor Analysis[J].Int J Gen Med,2021, 14:7159-7164.
[8]Xia ZF, Wu GS.Role of cytokines in sepsis and its current situation of clinical application[J].Zhonghua Shao Shang Za Zhi, 2019,35(1):3-7.
[9]Xue M, Xu F, Yang Y, et al.Diagnosis of sepsis with inflammatory biomarkers, cytokines, endothelial functional markers from SIRS patients[J].Medicine (Baltimore), 2022,101(7):e28681.
[10]Thiery-Antier N, Binquet C, Vinault S,et al.Epidemiology of Septic Shock Group Is Thrombocytopenia an Early Prognostic Marker in Septic Shock?[J] Crit Care Med, 2016,44(4):764-772.
[11]Ghimire S, Ravi S, Budhathoki R, et al.Current understanding and future implications of sepsis-induced thrombocytopenia[J]. Eur J Haematol, 2021,106(3):301-305.
[12]Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection[J]．Lancet, 1993, 341(8844)：515-518.
[13]Jekarl DW,Lee S,Kim M,et al.Procalcitonin as a prognostic marker for sepsis based on SEPSIS-3[J]. J Clin Lab Anal, 2019,33(9):e22996.
[14]Li S, Chen Z, Yan W. Expression and Clinical Trends of Pct Combined with Lactate Clearance in Sepsis[J].Evid Based Complement Alternat Med,2022.doi: 10.1155/2022/4382671
[15]Xie Y, Zhuang D, Chen H, et al.28-day sepsis mortality prediction model from combined serial interleukin-6, lactate, and procalcitonin measurements: a retrospective cohort study[J].Eur J Clin Microbiol Infect Dis,2023,42(1):77-85.
[16]陈慧敏，王立群，黄利民，等.降钙素原变化率对创伤后脓毒症患者抗生素合理使用的指导价值[J].东南国防医药，2020,22(4):408-410.
[17]Haltmeier T,Inaba K,Durso J,et al. Transthyretin at admission and over time as a marker for clinical outcomes in critically ill trauma patients:A prospective single-center study[J]. World J Surg,2020,44(1):115-123.
[18]刘远成，张劲远，李永海，等. 肛周坏死性筋膜炎患者4种血液生化指标对疾病预后的预测[J]. 医学研究生学报，2020,33(2):164-168.

相似文献/References:

[1]张 丽,侯毅翰,张民伟,等.降钙素原在血流感染中的临床应用分析[J].医学研究与战创伤救治(原医学研究生学报),2013,15(06):603.[doi:10.3969/j.issn.1672-271X.2013.06.016]
　ZHANG Li,HOU Yi-han,ZHANG Min-wei,et al.Cost-effective analysis of procalcitonin in the diagnosis of bloodstream infection[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2013,15(2):603.[doi:10.3969/j.issn.1672-271X.2013.06.016]
[2]黄凤楼,刁孟元,钱海飞,等.降钙素原及内毒素对腹腔感染脓毒症患者预后的评估[J].医学研究与战创伤救治(原医学研究生学报),2014,16(02):147.[doi:10.3969/j.issn.1672-271X.2014.02.011]
　HUANG Feng-lou,DIAO Meng-yuan,QIAN Hai-fei,et al.Prognostic value of procalcitonin and endotoxin concentrations for intra-abdominal sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2014,16(2):147.[doi:10.3969/j.issn.1672-271X.2014.02.011]
[3]刘 瑜,方 放,黄 方.糖皮质激素受体基因多态性与脓毒症临床转归的相关性研究[J].医学研究与战创伤救治(原医学研究生学报),2015,17(06):575.[doi:10.3969/j.issn.1672-271X.2015.06.005]
　LIU Yu,FANG Fang,HUANG Fang..Association of polymorphisms in glucocorticoid receptor with outcome of sepsis in a Chinese Han population[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2015,17(2):575.[doi:10.3969/j.issn.1672-271X.2015.06.005]
[4]郭剑,雷洁洁,章柏平,等.脓毒症患者连续性肾替代治疗时机选择及预后比较[J].医学研究与战创伤救治(原医学研究生学报),2018,20(01):37.[doi:10.3969/j.issn.1672-271X.2018.01.008]
　GUO Jian,LEI Jie-jie,ZHANG Bo-ping,et al.Comparison of timing and prognosis of continuous renal replacement therapy in patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(2):37.[doi:10.3969/j.issn.1672-271X.2018.01.008]
[5]窦燕,郭以河,孔晓飞,等.创伤弧菌脓毒症1例报道并文献复习[J].医学研究与战创伤救治(原医学研究生学报),2018,20(01):76.[doi:10.3969/j.issn.1672-271X.2018.01.018]
[6]李勇,宋薇.连续性血液净化联合益气活血法对脓毒症伴心肌功能障碍患者的临床疗效观察[J].医学研究与战创伤救治(原医学研究生学报),2018,20(03):225.[doi:10.3969/j.issn.1672-271X.2018.03.001]
　LI Yong,SONG Wei.The clinical efficacy of continuous blood purification combined with Yiqi Huoxue for the sepsis patients with myocardial dysfunction[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(2):225.[doi:10.3969/j.issn.1672-271X.2018.03.001]
[7]林青伟,宋景春,曾庆波,等.大黄素对脓毒症大鼠凝血紊乱治疗的作用[J].医学研究与战创伤救治(原医学研究生学报),2018,20(05):464.[doi:10.3969/j.issn.1672-271X.2018.05.004]
　LIN Qing-wei,SONG Jing-chun,ZENG Qing-bo,et al.Effect ofemodin on coagulation disorders of septic rats[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(2):464.[doi:10.3969/j.issn.1672-271X.2018.05.004]
[8]谢醒文,杨振宁,葛鑫,等.脓毒症相关凝血功能障碍对脓毒症患者预后的评估价值[J].医学研究与战创伤救治(原医学研究生学报),2020,22(2):161.[doi:10.3969/j.issn.1672-271X.2020.02.011]
　XIE Xing wen,YANG Zhen ning,GE Xin,et al.A clinical research on relationship between sepsisassociated coagulopathy and prognosis in patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(2):161.[doi:10.3969/j.issn.1672-271X.2020.02.011]
[9]钟林翠,宋景春,姜峻,等.血小板聚集率在评价脓毒症患者血小板功能及预后中的价值[J].医学研究与战创伤救治(原医学研究生学报),2020,22(3):249.[doi:10.3969/j.issn.1672-271X.2020.03.006]
　ZHONG Lin-cui,SONG Jing-chun,JIANG Jun,et al.Clinical study on platelet aggregation to evaluate platelet function and prognosis in patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(2):249.[doi:10.3969/j.issn.1672-271X.2020.03.006]
[10]曾庆波,宋景春,钟林翠,等.严重创伤与脓毒症患者凝血功能紊乱的比较研究[J].医学研究与战创伤救治(原医学研究生学报),2020,22(4):367.[doi:10.3969/j.issn.1672-271X.2020.04.007]
　ZENG Qing-bo,SONG Jing-chun,ZHONG Lin-cui,et al.Comparation of coagulation dysfunction between severe trauma and sepsis patients[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(2):367.[doi:10.3969/j.issn.1672-271X.2020.04.007]

备注/Memo

备注/Memo:
基金项目：南京市医学科技发展重点项目（ZKX19032）
更新日期/Last Update: 2023-07-24