离子间隙联合APACHEⅡ评分在脓毒症患者短期预后中的应用  

Prognostic value of anion gap combined with APACHE Ⅱ score for short-term clinical outcomes in patients with sepsis

作　　者：高兰[1] 李昊[1] 刘红娟[1] 闫晋琪 石秦东[1] Gao lan;Li Hao;Liu Hong-juan;Yan Jin-qi;Shi Qin-dong(Department of Critical Care Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院重症医学科,陕西西安710061

出　　处：《中国急救医学》2019年第12期1176-1180,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨离子间隙联合急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分在评估脓毒症患者短期临床预后中的应用价值.方法 回顾性分析西安交通大学第一附属医院2016年7月至2018年6月收治的符合研究标准的脓毒症患者104例,根据离子间隙及APACHEⅡ评分二分位结果将其分为四组,对各组的一般资料、生化检验结果、临床终点事件发生率进行比较;应用Kaplan-Meier生存分析比较各组随访期间生存率的变化;应用受试者工作特征(ROC)曲线判断离子间隙、APACHEⅡ评分及其联合指标对脓毒症患者住院期间及30 d死亡事件的诊断效能.结果 离子间隙>21.52 mmol/L并APACHEⅡ评分>17分的脓毒症患者住院期间(48.39%)及30d(51.61%)病死率较高,差异有统计学意义(P<0.05);Kaplan-Meier生存分析显示随访期间累计生存率降低最为显著(Log-rank P=0.003).ROC曲线下面积(AUC)判定离子间隙联合APACHEⅡ评分对脓毒症患者住院期间死亡风险的预测价值AUC 0.816(0.722 ~0.911)优于单一指标,对脓毒症患者30 d死亡风险的预测价值AUC 0.755(0.654~0.856)也优于单一指标.结论 离子间隙>21.52 mmol/L并APACHEⅡ评分>17分提示脓毒症患者短期不良临床结局发生率高,离子间隙联合APACHEⅡ评分能较好预测脓毒症患者短期临床结局.At present,little is known about the prognostic value of baseline anion gap(AG)combined with acute physiology and chronic health evaluation(APACHE)Ⅱ score for short-term clinical outcomes in patients with sepsis.Therefore,we investigated the prognostic significance of baseline AG combined with APACHE Ⅱ score for short一term mortality in patients with sepsis.Methods In this single-center prospective observational cohort study,a total of 104 patients with sepsis were enrolled and follow-up at least 30 days from July 2016 to 2018 June.The relationship between baseline AG combined with APACHE Ⅱ score and all-cause mortality(in-hospital and 30-day)were analyzed by categorizing the patients into four groups according to the binary results of AG and APACHE Ⅱ score.Kaplan-Meier survival analysis was used to compare the survival rates of each group during follow-up.ROC curve was used to determine the diagnosis value of markers in short-term outcomes.Results The in-hospital mortality and 30-day mortality were 48.39%and 51.61%respectively in group which comprised patients with AG>21.52 mmol/L and APACHE Ⅱ score>17.Kaplan-Meier survival analysis showed the curve of these patients gone down most notably.The area under the ROC curve of AG plus APACHE Ⅱ score at in-hospital(0.816,95% CI 0.722-0.911)and 30-day(0.755,95% CI 0.654-0.856)time point for the prediction of all-cause death event were higher than that of AG or APACHE Ⅱ score alone.Conclusion AG>21.52 mmol/L combined with APACHE Ⅱ score>17 is significantly associated with adverse short一term clinical outcomes.AG combined with APACHE Ⅱ score can add the prognostic value for predicting short-term clinical outcomes in patients with sepsis.

关 键 词：离子间隙 急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分 脓毒症 短期预后 

分 类 号：R459.7[医药卫生—急诊医学]