序贯器官衰竭评分联合可溶性程序性死亡因子-1对脓毒症患者的预后评估价值  

The prognostic evaluation of SOFA score combined with soluble programmed death-1 on the patients with sepsis

作　　者：赵永祯[1] 梅雪[1] 贾育梅[2] 郭树彬[1] Zhao Yong-zhen;Mei Xue;Jia Yu-mei;Guo Shu-bin(Department of Emergency,Beijing Chaoyang Hospital of Capital Medical University, Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京100020 [2]首都医科大学附属北京朝阳医院内分泌科,北京100020

出　　处：《中国急救医学》2020年第12期1177-1181,共5页Chinese Journal of Critical Care Medicine

基　　金：首都临床特色应用研究专项课题(Z171100001017057);北京协和医学基金-睿E(睿意)急诊医学研究专项基金(R2018001);北京市科协金桥工程种子资金(JQ18057)。

摘　　要：目的探讨序贯器官衰竭评估(SOFA)评分联合可溶性程序性死亡(sPD-1)对急诊脓毒症患者28 d病死率的预测能力。方法前瞻性收集40例健康志愿者和92例脓毒症患者临床资料。根据28 d转归将脓毒症患者分为生存组(63例)和死亡组(29例)。检测所有患者脓毒症sPD-1、降钙素原(PCT)、C-反应蛋白(CRP)水平,并记录SOFA评分和急性生理学与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分。通过Logistic回归分析确定脓毒症患者28 d病死率的独立预测因素,应用受试者工作特征曲线(ROC曲线)比较sPD-1与各项指标对脓毒症预后的预测能力。结果脓毒症患者外周血的sPD-1水平高于健康志愿者[sPD-1(ng/mL):1.81(1.16~2.90)vs.0.77(0.35~1.26),P<0.001]。死亡组年龄[岁:69(65~77)vs.59(47~71)]、sPD-1[ng/mL:1.64(1.06~2.23)vs.3.17(1.66~5.39)]、PCT[ng/mL:7.57(4.64~10.57)vs.4.42(1.40~6.20)]、CRP[mg/L:112(58~160)vs.73(45~132)]、APACHEⅡ评分[分:23(19~26)vs.16(14~20)]和SOFA评分[分:10(7~13)vs.6(5~8)]均高于生存组(P<0.05)。Logistic回归分析显示,sPD-1、SOFA评分和APACHEⅡ评分均是判断脓毒症患者28 d病死率的独立预测因素(P<0.05)。sPD-1、SOFA评分和APACHEⅡ评分判断28 d病死率的曲线下面积(AUC)分别为0.753、0.810和0.812。SOFA评分联合sPD-1 AUC值最高(0.852),敏感度、特异度、阳性预测值和阴性预测值分别为75.9%、85.7%、71.0%和88.5%。结论血清sPD-1水平是判断脓毒症患者28 d病死率的独立预测因素。SOFA评分联合sPD-1对符合Sepsis 3.0标准的急诊脓毒症患者28 d病死率有较好的预测能力。Objective To evaluate the predictive ability of sequential organ failure assessment(SOFA)score combined with soluble programmed death-1(sPD-1)for 28-day mortality of patients with sepsis in the emergency department(ED).Methods A total of 40 healthy volunteers and 92 septic patients were recruited in this prospective cohort study.All the patients with sepsis were also divided into the survival group(63 cases)and death group(29 cases)according to the 28-day outcomes.Levels of sPD-1,procalcitonin(PCT),C-reactive protein(CRP),SOFA score,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were examined.Logistic regression was used to determine independent risk factors of 28-day mortality in the patients with sepsis.Receiver operating characteristic curve(ROC curve)was used to compare the predictive capacity of the sPD-1 and relevant variables in the prognostic evaluation.Results Level of sPD-1 was higher in septic patients than in healthy volunteers[sPD-1(ng/mL):1.81(1.16-2.90)vs.0.77(0.35-1.26),P<0.001].Meanwhile,age,the levels of sPD-1,PCT,CRP,APACHEⅡscore,and SOFA score were higher in the death group compared with the survival group[age(years):69(65-77)vs.59(47-71),sPD-1(ng/mL):1.64(1.06-2.23)vs.3.17(1.66-5.39),PCT(ng/mL):7.57(4.64-10.57)vs.4.42(1.40-6.20),CRP(mg/L):112(58-160)vs.73(45-132),APACHEⅡ(score):23(19-26)vs.16(14-20),SOFA(score):10(7-13)vs.6(5-8),all P<0.05].Logistic regression suggested that sPD-1,SOFA score and APACHEⅡscore were independent risk factors for 28-day mortality of septic patients(P<0.05).Area under the curve(AUC)of sPD-1,SOFA score and APACHEⅡI score for 28-day mortality was 0.753,0.810 and 0.812,respectively.The AUC of the SOFA score combined with sPD-1 was 0.852,and the sensitivity,specificity,positive predictive value,and negative predictive value of the combination were 75.9%,85.7%,71.0%and88.5%,respectively.Conclusion Serum sPD-1 is an independent risk factor for 28-day mortality of septic patients.SOFA score combined with sPD-1 show valuable ability for the p

关 键 词：可溶性程序性死亡因子-1(sPD-1) 序贯器官衰竭评估(SOFA)评分 脓毒症 急性生理及慢性健康情况评价系统Ⅱ(APACHEⅡ)评分 预后评估 

分 类 号：R459.7[医药卫生—急诊医学]