APACHEⅡ和SOFA评分联合血清降钙素原对鲍曼不动杆菌血流感染患者预后的预测价值  

Assessment of the value of APACHEⅡ score system, SOFA score and procalcitonin in Acinetobacter baumannii bloodstream infection

作　　者：周文杰[1] 张小亚[1] 张珺[1] 王晓红[1] 杨晓军[1] 马希刚[1] 

机构地区：[1]宁夏医科大学总医院ICU,宁夏银川750004

出　　处：《中国急救医学》2017年第3期221-225,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金项目（81260853）;国家临床重点专科建设项目（2011）

摘　　要：目的探讨急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）、序贯器官功能衰竭评分（SOFA）及血清降钙素原（PCT）对鲍曼不动杆菌血流感染患者预后的预测价值。方法收集我院2009—01。2015—12收治的112例鲍曼不动杆菌血流感染患者的临床资料，包括性别、年龄、入院APACHEⅡ评分及血流感染当日APACHEⅡ评分、人院SOFA评分及血流感染当日SOFA评分、血清PCT、住ICU天数、总住院天数、体温、白细胞计数、中性粒细胞百分比、28d结局等，绘制受试者工作特征曲线（ROC曲线）并计算曲线下面积（AUC），比较APACHEⅡ、SOFA评分及血清PCT对鲍曼不动杆菌血流感染患者预后的评估价值。结果112例患者中，死亡66例（58．93％），存活46例（41．07％）。与存活组比较，死亡组人院APACHEⅡ评分（20．47±7．39VS．12．59±5．26，P〈0．001）、血流感染当日APACHEⅡ评分（26．56±8．16VS．13．09±4．99，P〈0．001）、入院SOFA评分（8．94±4．17 vs．5．11±2．44，P〈0．001）、血流感染当日SOFA评分（11．86±4．72VS．4．24±3．06，P〈0．001）均明显升高。死亡组与存活组血清PCT水平比较差异有统计学意义（P〈0．001）。单独指标中血流感染当日APACHEⅡ评分预测价值最大，AUC值0．920（95％C10．871—0．969），当截断值为16分时，敏感度92．4％，特异度78．3％。PCT联合血流感染当日APACHEⅡ评分及血流感染当日SOFA评分的AUC值0．935（95％CI 0．893-0．977），在联合指标中预测价值更大。结论APACHEⅡ评分、SOFA评分及血清PCT可作为鲍曼不动杆菌血流感染患者预后评价指标。PCT联合血流感染当日APACHEⅡ评分及血流感染当日SOFA评分对评估病情严重程度及预后具有重要意义。Objective To explore acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）, sequential organ failure assessment （SOFA） score and procalcitonin in Acinetobacter baumannii bloodstream infection. Methods Clinical data was collected on 112 patients with Acinetobacter baumannii bloodstream infections during January 2009 to December 2015, including gender, age, APACHEⅡ score at admission and APACHEⅡ score on bloodstream infections day, SOFA score at admission and SOFA score on blood stream infections day, procalcitonin, length of ICU stay, the total hospitalization days, body temperature, white blood cell count, neutrophilic granulocyte percentage, 28 d end etc. The receiver operating characteristic curve （ROC） was drawn and the area under the curve （AUC） was calculated. APACHE Ⅱ, SOFA score and procalciton in Acinetobacter baumannii bloodstream infections in patients were compared to assess the value of prognosis. Results In 112 patients, 66 cases died （58.93%）, 46 cases survived （41.07%）. Compared with group survival, death group admission APACHEⅡ score （20.47±7.39 vs.12.59±5.26, P 〈 0.001）, bloodstream infections on APACHEⅡ score （26.56± 8.16 vs.13.09±4.99, P 〈 0.001）, admission SOFA score （8.94±4.17 vs. 5.11±2.44, P〈 0.001）, blood- stream infections on SOFA score （11.86±4.72 vs. 4.24± 3.06, P 〈 0.001 ） were significantly increased. Death and survival group, two groups of procalcitonin comparative difference was statistically significant （P 〈 0.001）. Individual indicators in the bloodstream infections on APACHE Ⅱ score prediction value was the largest, AUC value of 0.920 （95% CI 0.871-0.969）, when the cutoff value of 16, the sensitivity of 92.4%, 78.3% specific degrees. PCT joint bloodstream infections on APACHEⅡ score and SOFA score the AUC value was 0.935 （95% CI 0.893±0.977）, in the joint index prediction value was bigger. Conclusion APACHE Ⅱ score, SOFA score and procalcitonin can be used as Acinetobacter baumannii

关 键 词：急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ) 序贯器官功能衰竭评分(SOFA) 降钙素原(PCT) 鲍曼不动杆菌 血流感染 

分 类 号：R576[医药卫生—消化系统]