肝素结合蛋白联合SOFA评分对老年脓毒症患者预后的早期预测价值  

The value of heparin-binding protein combined with SOFA score in predicting the prognosis of elderly patients with sepsis

作　　者：刘艺 马林沁 吴彩军 Liu Yi;Ma Linqin;Wu Caijun(Department of Emergency Medicine,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing,100700;Institute of Sepsis,University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院急诊科,北京100700 [2]北京中医药大学脓毒症研究所,北京100700

出　　处：《中华急诊医学杂志》2020年第12期1613-1617,共5页Chinese Journal of Emergency Medicine

基　　金：东直门医院特殊人才引进科研启动专项(2018RC01);中央高校基本科研业务费专项基金资助(2019-JYB-JS-037)。

摘　　要：目的探讨肝素结合蛋白联合SOFA评分对老年脓毒症患者出现脓毒性休克及28 d死亡风险的早期预测价值。方法选择2019年10月至2020年4月北京中医药大学东直门医院急诊科及EICU收治的65例老年脓毒症患者,依据Sepsis 3.0定义分为脓毒症组与脓毒性休克组,依据28 d是否存活分为存活组和死亡组.比较两组患者的一般情况、序贯器官衰竭(Sequential Organ Failure Assessment,SOFA)评分、肝素结合蛋白(heparin-binding protein,HBP)、白细胞计数(white blood cell count,WBC)、C-反应蛋白(C-reactive protein,CRP)和降钙素原(procalcitonin,PCT),并比较以上指标在28 d存活和死亡组之间的差异;绘制受试者工作特征曲线(ROC)评估上述指标中有差异者对出现脓毒性休克及28 d死亡的早期预测价值。结果脓毒性休克组的SOFA评分、HBP、CRP、PCT较脓毒症组均显著升高(均P<0.05)。死亡组的SOFA评分、HBP、PCT较存活组均显著升高(均P<0.05)。ROC曲线显示HBP联合SOFA评分诊断脓毒性休克的ROC曲线下面积(0.928)大于PCT联合SOFA评分(0.852)、PCT(0.796)和HBP(0.696)。PCT联合SOFA评分预测28 d死亡的ROC曲线下面积(0.924)大于HBP(0.917)、HBP联合SOFA评分(0.913)和PCT(0.822)。结论HBP联合SOFA评分对老年脓毒症患者发生脓毒性休克及死亡风险有较好的早期预测价值。Objective To explore the value of heparin-binding protein combined with SOFA score in predicting the occurrence of septic shock and 28-day mortality in elderly patients with sepsis.Methods A total of 65 elderly patients with sepsis were admitted to the Emergency Department and Emergency Intensive Care Unit(EICU)of Dongzhimen Hospital of Beijing University of Chinese Medicine from October 2019 to April 2020.Patients were divided into the sepsis and septic shock groups based on Sepsis 3.0 definition,the survivor and non-survivor groups based on whether they were survive on day 28.Patient's general characteristics,sequential organ failure assessment(SOFA)score,heparin-binding protein(HBP),white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)were compared between the sepsis and septic shock groups,and the survivor and non-survivor groups.In addition,the receiver operating characteristic curve(ROC)was drawn to predict the occurrence of septic shock and 28-day mortality in elderly patients with sepsis.Results The SOFA score,HBP,CRP,and PCT in the septic shock group were significantly higher than those in the sepsis group(all P<0.05).The SOFA score,HBP,and PCT in the non-survivor group were significantly higher than those in the survivor group(all P<0.05).For diagnosing the occurrence of septic shock,the areas under the curve of HBP combined SOFA score(0.928)was bigger than that of PCT combined SOFA score(0.825),HBP(0.696),and PCT(0.796).In addition,for predicting the 28-day mortality,the areas under the curve of PCT combined SOFA score(0.924)was bigger than that of HBP(0.917),HBP combined SOFA score(0.913),and PCT(0.822).Conclusions HBP combined with SOFA score has a good value in predicting the risk of septic shock and death in elderly patients with sepsis.

关 键 词：老年患者 脓毒症 脓毒性休克 肝素结合蛋白 SOFA评分 

分 类 号：R459.7[医药卫生—急诊医学]