脓毒症并发意识障碍患者28 d神经功能预后的危险因素分析  

Analysis of risk factors for the 28-day neurological outcome in patients with sepsis complicated with consciousness disorder

作　　者：袁中信 姚鹏[1,2] 何亚荣 谷志寒[1,2] 赵杰 周亚雄 曹钰[1,2] YUAN Zhongxin;YAO Peng;HE Yarong;GU Zhihan;ZHAO Jie;ZHOU Yaxiong;CAO Yu(Emergency Department/Emergency Medical Laboratory,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Disaster Medical Center,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院急诊科/急诊医学研究室,成都610041 [2]四川大学灾难医学中心,成都610041

出　　处：《华西医学》2020年第11期1344-1349,共6页West China Medical Journal

基　　金：中国博士后科学基金(特别资助)(2020T130445);成都市科技惠民项目(2016-HM02-00099-SF);四川大学华西医院1·3·5工程项目(ZYJC18019)。

摘　　要：目的探究影响脓毒症并发意识障碍患者入院后28 d神经功能预后的危险因素,基于此创建简易评分,并评估其对患者28 d不良神经功能预后的预测价值。方法回顾性收集并分析2017年6月1日08:00—2018年5月31日23:59就诊于四川大学华西医院急诊科的脓毒症并发意识障碍患者的人口学资料、临床资料、28 d存活情况及神经功能,通过单因素分析和多因素logistic回归分析筛选出影响脓毒症并发意识障碍患者28 d不良神经功能预后的独立危险因素,根据受试者工作特征曲线截断值将上述连续变量转换为二分类变量并进行赋值,创建简易评分,验证其对脓毒症并发意识障碍患者28 d不良神经功能预后的预测效能。结果最终纳入149例脓毒症并发意识障碍患者,其中男103例(69.1%),女46例(30.9%);平均年龄(58.2±18.6)岁;28 d神经功能不良患者72例(48.3%)。多因素logistic回归分析发现,总胆汁酸[比值比(odds ratio,OR)=1.040,95%置信区间(confidence interval,CI)(1.004,1.077),P=0.027]、血氨[OR=1.014,95%CI(1.001,1.027),P=0.030]、肺部感染[OR=3.255,95%CI(1.401,7.566),P=0.006]、格拉斯哥昏迷评分[OR=0.837,95%CI(0.739,0.949),P=0.005]是脓毒症并发意识障碍患者28 d不良神经功能预后的独立影响因素。基于上述4项指标构建的简易评分系统预测脓毒症并发意识障碍患者短期不良神经功能预后的曲线下面积为0.754[95%CI(0.676,0.832)],灵敏度和特异度分别为79.2%和63.6%。结论对于脓毒症并发意识障碍的急诊患者,基于早期格拉斯哥昏迷评分、是否肺部感染、血氨和总胆汁酸等指标的简易评分系统具有良好的短期神经功能预测价值。Objective To investigate the risk factors affecting the 28-day neurological outcome after admission of patients with sepsis complicated with consciousness disorder,create a simple scoring system,and evaluate its predictive value for the poor neurological outcome.Methods We retrospectively collected and analyzed the demographic data,clinical data,28-day survival status and neurologic outcome of patients with sepsis complicated with disturbance of consciousness admitted to the Emergency Department of West China Hospital of Sichuan University between June 1st,2017 and May 31st,2018.Independent risk factors for the 28-day neurologic outcome of patients with disturbance of consciousness were obtained through univariate analyses and multiple logistic regression analysis,and then the continuous variables of risk factors were converted to binary variables according to the cut-off values from receiver operating characteristic(ROC)curve analysis,a simple scoring system was established and it’s predictive value for 28-day neurological outcome of patients with sepsis complicated with consciousness disorder was assessed.Results A total of 149 patients with sepsis complicated with consciousness disorder were included in this study,including 103 males(69.1%)and 46 females(30.9%),with an average age of(58.2±18.6)years old.There were 72 patients(48.3%)with poor outcome of neurological function on Day 28 after admission.Multiple logistic regression analysis revealed that total bile acid[odds ratio(OR)=1.040,95%confidence interval(CI)(1.004,1.077),P=0.027],blood ammonia[OR=1.014,95%CI(1.001,1.027),P=0.030],pulmonary infection[OR=3.255,95%CI(1.401,7.566),P=0.006],and Glasgow Coma Score(GCS)[OR=0.837,95%CI(0.739,0.949),P=0.005]were independent influencing factors for the poor neurological function in patients with sepsis complicated with consciousness disorder on Day 28 after admission.The area under the ROC curve predicting the 28-day poor neurological function was 0.754[95%CI(0.676,0.832)],and the sensitivity and specificity wer

关 键 词：脓毒症 意识障碍 神经功能 预后 

分 类 号：R459.7[医药卫生—急诊医学] R749.1[医药卫生—治疗学]