HCT-ALB对脓毒症诊断及预后评估的价值  

VALUE OF THE DIFFERENCE BETWEEN HEMATOCRIT AND ALBUMIN IN THE DIAGNOSIS AND PROGNOSTIC EVALUATION OF SEPSIS

作　　者：王万腾 顾华丽[1] 乔霞 辛兆瑞 王帅 孙运波[4] WANG Wanteng;GU Huali;QIAO Xia;XIN Zhaorui;WANG Shuai;SUN Yunbo(Department of Emergency,The Affiliated Hospital of Qingdao University,Qingdao 266071,China)

机构地区：[1]青岛大学附属医院急诊内科,山东青岛266071 [2]青岛大学附属医院烧伤整形外科 [3]威海市立医院重症医学科 [4]青岛大学附属医院重症医学科

出　　处：《青岛大学学报（医学版）》2022年第5期677-681,共5页Journal of Qingdao University(Medical Sciences)

基　　金：吴阶平医学基金会临床科研专项资助基金项目(HRJJ20171017)。

摘　　要：目的探讨血细胞比容(HCT)与血浆清蛋白(ALB)的差值(HCT-ALB)在脓毒症诊断以及预测脓毒症死亡风险中的价值。方法回顾性分析青岛大学附属医院312例脓毒症病人的临床资料,并随机选取同时期696例非脓毒症病人作为对照组。收集两组病人的临床资料并进行1∶1倾向得分匹配(PSM),分析匹配前后两组病人HCT-ALB的差异。绘制受试者工作特征曲线(ROC曲线),评价HCT-ALB对脓毒症的诊断价值。将脓毒症病人按全因死亡与否分为死亡亚组与生存亚组,比较两组间HCT-ALB的差异,应用PSM平衡混杂因素的影响,绘制ROC曲线评估HCT-ALB对预测脓毒症病人死亡的价值。结果PSM前后,脓毒症组的HCT-ALB均显著高于对照组(Z=-19.590、-10.480,P<0.01)。HCT-ALB诊断脓毒症的ROC曲线下面积(AUC)为0.885,最佳截断值为5.15,其诊断的灵敏度为83%,特异度为82%。在脓毒症亚组中,PSM前后死亡组HCT-ALB也明显高于生存组(Z=-3.831、-2.881,P<0.01)。ROC曲线分析显示,HCT-ALB预测脓毒症病人死亡的AUC为0.661,最佳截断值为14.15,其预测的灵敏度为50%,特异度为77%。结论脓毒症病人的HCT-ALB显著高于非脓毒症病人,HCT-ALB对脓毒症具有诊断价值,但HCT-ALB预测脓毒症死亡的效能不佳。Objective To investigate the value of the difference between hematocrit and serum albumin(HCT-ALB)in diagnosing sepsis and predicting the risk of sepsis-induced death.Methods A retrospective analysis was performed for the clinical data of 312 patients with sepsis who were admitted to The Affiliated Hospital of Qingdao University,and 696 patients without sepsis who were treated during the same period of time were randomly selected as control group.Clinical data were collected from the two groups,and propensity score matching(PSM)at a ratio of 1∶1 was performed to analyze the difference in HCT-ALB between the two groups before and after matching.The receiver operating characteristic(ROC)curve was plotted to investigate the value of HCT-ALB in the diagnosis of sepsis.The patients with sepsis were divided into death and survival subgroups according to the presence or absence of all-cause death,and HCT-ALB was compared between the two groups;PSM was used to balance the influence of confounding factors,and the ROC curve was plotted to investigate the value of HCT-ALB in predicting death in patients with sepsis.Results The sepsis group had a significantly higher HCT-ALB than the control group before and after PSM(Z=-19.590,-10.480;P<0.01).In the diagnosis of sepsis,HCT-ALB had an area under the ROC curve(AUC)of 0.885,with a sensitivity of 83%and a specificity of 82%at the optimal cut-off value of 5.15.In the sepsis subgroups,the death group also had a significantly higher HCT-ALB than the survival group before and after PSM(Z=-3.831,-2.881;P<0.01).The ROC curve analysis showed that HCT-ALB had an AUC of 0.661 in predicting the death of patients with sepsis,with a sensitivity of 50%and a specificity of 77%at the optimal cut-off value of 14.15.Conclusion Patients with sepsis have a significantly higher HCT-ALB than those without sepsis.HCT-ALB has a certain value in the diagnosis of sepsis,while it has poor performance in predicting the death of sepsis.

关 键 词：脓毒症 血细胞比容 血清白蛋白 诊断 临床实验室技术 

分 类 号：R631[医药卫生—外科学] R446.11[医药卫生—临床医学]