血清白蛋白联合急诊脓毒症死亡风险评分对脓毒症患者预后价值的研究  

Prognostic value of the combination of the plasma albumin and the mortality in emergency department sepsis score in patients with sepsis

作　　者：李建红[1] 柴艳芬[1] 曹超[1] 

机构地区：[1]天津医科大学总医院急诊医学科,300052

出　　处：《中华临床医师杂志（电子版）》2016年第8期76-80,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：天津市应用基础与前沿技术研究计划(13JCYBJC37500);天普研究基金(UF201315)

摘　　要：目的探讨血清白蛋白(ALB)能否预测急诊脓毒症患者28 d病死率,以及ALB联合急诊脓毒症死亡风险评分(MEDS)对于脓毒症患者预后的意义。方法采用回顾性研究方法,选取2013年7月至2014年12月天津医科大学总医院急诊医学科病房195例脓毒症患者,检测患者入院时ALB,并记录其余各项生理及实验室指标。以进入研究后28 d生存情况分为存活组与死亡组,比较两组ALB水平、MEDS、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、脓毒症序贯性器官功能衰竭评分(SOFA)有无差异,并进行Logistic回归分析确定脓毒症患者28 d死亡的独立预测因素,采用受试者工作特征曲线(ROC曲线)比较ALB及各评分系统对预后的判定能力。结果 195例脓毒症患者28 d病死率为14.36%。死亡组患者年龄、MEDS、APACHEⅡ、SOFA评分高于存活组,而ALB水平低于存活组。死亡组患者中感染部位中的肺部感染及泌尿系感染,基础疾病中的心血管疾病及糖尿病比例均较存活组高(P<0.05)。多变量Logistic回归分析显示ALB水平、APACHEⅡ及SOFA评分是患者28 d预后的独立危险因素(P<0.05)。ALB水平、MEDS评分、APACHEⅡ评分、SOFA评分及ALB联合MEDS评分的曲线下面积(AUC)依次为0.743、0.756、0.781、0.760及0.789。结论 (1)ALB水平是预测脓毒症患者28 d预后的独立危险因素;(2)ALB水平联合MEDS评分较APACHEⅡ评分及SOFA评分可更好地评估脓毒症患者28 d预后。Objective To investigate the value of plasma albumin in predicting 28-day mortalityof sepsis patients in emergency department, and the power of combination of the plasma albumin and themortality in emergency department sepsis score （MEDS） for predicting the outcome of patients with sepsis.Methods A retrospective study was conducted. A total of 195 sepsis patients treated in the EmergencyMedicine Department of the General Hospital of Tianjin Medical University from July 2013 to December2014 were enrolled, plasma albumin and other clinical and laboratory variables were collected in the first24-hour. The 28-day outcome of survival or death was considered as the end point of the study. The plasmaalbumin levels, MEDS, acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） score, andsequential organ failure assessment （SOFA） were compared respectively between survivors andnon-survivors. Logistic regression analysis was used to determine the independent predictors for 28-daymortality. Discrimination of plasma albumin levels and the score systems was assessed with the areas underthe receiver operating characteristics （ROC） curve （AUC）. Results Among the 195 patients with sepsis,the mortality rate within 28 days after admission was 14.36%. Compared with survivors, the patients innon-survival group was older and with higher MEDS, APACHEⅡ, SOFA scores and lower levels ofplasma albumin, and they had higher ratio of lung and urinary system infection, and higher ratio ofunderlying diseases such as cardiovascular disease and diabetes mellitus （P〈0.05）. It was identified byLogistic regression that the plasma ALB level, APACHEⅡ, and SOFA scores were significantlyindependent factors in 28-day death prediction in patients with sepsis （P〈0.05）. The areas under the ROCcurve （AUC） were 0.743, 0.756, 0.781, 0.760, 0.789 for ALB level, MEDS, APACHEⅡ and SOFA scoresrespectively. Conclusions Plasma albumin is an independent predictor of 28-day mortality in patientswith sepsis. Plasma album

关 键 词：脓毒症 血清白蛋白 急诊脓毒症死亡风险评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]