降钙素原与D-二聚体联合序贯器官衰竭评分对老年脓毒症患者病情及预后评估的价值  

Value of procalcitonin and D-dimer combined sequential official failure score in evaluation of elderly patients with sepsis and their prognosis

作　　者：赵刚 郁红萍 张一凡[3] ZHAO Gang;YU Hong-Ping;ZHANG Yi-Fan(Department of Geriatrics,Shanghai Fifth Rehabilitation Hospital,Shanghai 201620,China;Department of Infectious Diseases,Songjiang Central Hospital,Shanghai 201620,China;Department of Emergency,Songjiang Central Hospital,Shanghai 201620,China)

机构地区：[1]上海市第五康复医院老年医学科,上海201620 [2]上海市松江区中心医院感染科,上海201620 [3]上海市松江区中心医院急诊与危重症科,上海201620

出　　处：《中华老年多器官疾病杂志》2021年第5期355-358,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的探讨降钙素原(PCT)与D-二聚体(D-D)联合序贯器官衰竭评分(SOFA)对老年脓毒症患者病情判断和预后的评估价值。方法回顾性分析2016年1月至2020年1月于上海市第五康复医院住院并诊断为脓毒症的117例老年患者(年龄≥60岁)的临床资料,记录患者入院24h内PCT、D-D、SOFA评分及28d预后。根据病情严重程度将患者分为脓毒性休克组(32例)和脓毒症组(85例);根据28d预后将患者分为死亡组(35例)和存活组(82例),比较各组的指标差异。绘制受试者工作特征曲线(ROC),分析上述指标单独或联合应用对老年脓毒症患者预后的评估价值。采用SPSS 17.0统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ^(2)检验。通过logistic回归分析各预测因子对预后的影响。结果脓毒性休克组患者PCT、D-D、SOFA评分均明显高于脓毒症组[PCT:7.25(3.93,10.56)和2.55(1.59,5.45)μg/L;D-D:5.40(3.24,6.95)和2.59(1.68,5.61)mg/L;SOFA评分:8.0(6.0,11.0)和6.0(4.0,7.0)分],差异均有统计学意义(P<0.05)。死亡组患者PCT、D-D、SOFA评分均明显高于存活组[PCT:3.94(2.89,11.36)和2.79(1.67,6.50)μg/L;D-D:4.16(2.67,7.10)和2.88(1.74,5.82)mg/L;SOFA评分:8.0(7.0,11.0)和6.0(4.0,8.0)分],差异均有统计学意义(P<0.05)。ROC曲线分析显示,PCT、D-D、SOFA评分、PCT+D-D+SOFA评分的ROC曲线下面积(AUC)分别为0.657、0.633、0.715、0.748,说明各指标对老年脓毒症患者28d预后均有一定预测价值,以三者联合预测价值最大,其灵敏度为97.1%,特异度为59.8%。结论PCT、D-D、SOFA评分是评估老年脓毒症患者病情严重程度及预后的预测指标,三者联合应用具有更高的评估价值。Objective To evaluate procalcitonin(PCT)and D-dimer(D-D)combined sequential organ failure assessment(SOFA)in the diagnosis and prognosis of the elderly patients with sepsis.Methods A retrospective study was conducted of the clinical data of 117 elderly patients(age≥60 years old)who were hospitalized in Shanghai Fifth Rehabilitation Hospital from January 2016 to January 2020.PCT,D-D,SOFA scores and 28-day prognosis of the patients were recorded.According to the severity of disease,the patients were divided into septic shock group(n=32)and sepsis group(n=85).According to 28-day prognosis,the patients were divided into death group(n=35)and survival group(n=82).The two groups were compared for the indicators.Receiver operating characteristic curve(ROC)was drawn to analyze the prognostic value of the above indicators alone or in combination.Data analysis was performed using SPSS statistics 17.0.Depending on the data type,t-test,rank sum test orχ^(2)test is used.Logistic regression was performed to analyze the prognostic value of each predictor.Results The scores of PCT,D-D and SOFA in the septic shock group were significantly higher than those in the sepsis group[PCT(μg/L):7.25(3.93,10.56)vs 2.55(1.59,5.45);D-D(mg/L):5.40(3.24,6.95)vs 2.59(1.68,5.61);SOFA:8.0(6.0,11.0)vs 6.0(4.0,7.0)],and the differences were statistically significant(P<0.05).The PCT,D-D and SOFA in the death group were significantly higher than those in the survival group[PCT(μg/L):3.94(2.89,11.36)vs 2.79(1.67,6.50),D-D(mg/L):4.16(2.67,7.10)vs 2.88(1.74,5.82),SOFA:8.0(7.0,11.0)vs 6.0(4.0,8.0)],and the differences were statistically significant(P<0.05).The area under the ROC curve(AUC)was 0.657 for PCT,0.633 for D-D,0.715 for SOFA and 0.748 for PCT+D-D+SOFA,indicating that each index was predictive of the 28-day prognosis of the elderly patients with sepsis.The three indexes in combination performed best with a sensitivity of 97.1%and a specificity of 59.8%.Conclusion PCT,D-D and SOFA scores are the predictors of severity and prognosis of the eld

关 键 词：老年人 脓毒症 降钙素原 D-二聚体 序贯器官衰竭评分 

分 类 号：R631[医药卫生—外科学]