血清降钙素原水平和APACHEⅡ评分对老年脓毒症患者预后的预测价值分析  

Value of serum procalcitonin and acute physiology and chronic health evaluationⅡscore on predicting the prognosis of sepsis in elderly patients

作　　者：刘慧琳[1] 傅义程 郝靖欣[1] 张福春[1] 刘桂花[2] Liu Huilin;Fu Yicheng;Hao Jingxin;Zhang Fuchun;Liu Guihua(Department of Geriatrics,Peking University Third Hospital,Beijing 100091,China;Department of Emergency,Peking University Third Hospital,Beijing 100091,China)

机构地区：[1]北京大学第三医院老年内科,北京100191 [2]北京大学第三医院急诊科,北京100191

出　　处：《中华危重病急救医学》2023年第1期56-60,共5页Chinese Critical Care Medicine

基　　金：国家重点研发计划资助项目(2020YFC2008804)。

摘　　要：目的:评价降钙素原(PCT)及急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)对老年脓毒症患者预后的预测价值。方法:采用回顾性队列研究方法,选择2020年3月至2021年6月北京大学第三医院急诊内科和老年内科收治的老年脓毒症患者为研究对象,通过电子病历系统收集患者入院24 h内的一般资料、实验室检查指标、APACHEⅡ评分及住院期间和出院1年预后。采用单因素及多因素分析影响老年脓毒症预后的变量;绘制Kaplan-Meier生存曲线预测患者住院及随访期间生存率。结果:共纳入116例患者,其中存活55例,死亡61例。单因素Cox分析显示,影响预后的临床变量分别为血乳酸〔Lac,风险比(HR)=1.16,95%可信区间(95%CI)为1.07~1.26,P<0.001〕、PCT(HR=1.02,95%CI为1.01~1.04,P<0.001)、丙氨酸转氨酶(ALT,HR=1.00,95%CI为1.00~1.00,P=0.143)、天冬氨酸转氨酶(AST,HR=1.00,95%CI为1.00~1.01,P=0.014)、乳酸脱氢酶(LDH,HR=1.00,95%CI为1.00~1.00,P<0.001)、羟丁酸脱氢酶(HBDH,HR=1.00,95%CI为1.00~1.00,P=0.001)、肌酸激酶(CK,HR=1.00,95%CI为1.00~1.00,P=0.002)、肌酸激酶同工酶(CK-MB,HR=1.01,95%CI为1.01~1.02,P<0.001)、血钠(Na,HR=1.02,95%CI为0.99~1.05,P=0.183)、血尿素氮(BUN,HR=1.02,95%CI为0.99~1.05,P=0.139)、纤维蛋白原(FIB,HR=0.85,95%CI为0.71~1.02,P=0.078)、中性粒细胞比例(NEU%,HR=0.99,95%CI为0.97~1.00,P=0.114)、血小板计数(PLT,HR=1.00,95%CI为0.99~1.00,P=0.108)、总胆汁酸(TBA,HR=1.01,95%CI为1.00~1.02,P=0.096)。多因素分析显示,PCT是老年脓毒症患者预后的独立影响因素(HR=1.03,95%CI为1.01~1.05,P=0.002)。Kaplan-Meier生存曲线显示,PCT≤0.25μg/L与PCT>0.25μg/L患者住院及随访期间总体生存率无明显差异(P=0.220);APACHEⅡ评分>27分患者的总体生存率明显低于APACHEⅡ评分≤27分患者(P=0.015)。结论:血清PCT水平是老年脓毒症患者预后的有效影响因素;APACHEⅡ评分越高病死率越高,尤其>27分时老年脓毒症患者的病死率明显升高。Objective To explore the value of serum procalcitonin(PCT)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score on predicting prognosis of elderly patients with sepsis.Methods A retrospective cohort study,patients with sepsis who admitted to the department of emergency and the department of geriatric medicine of Peking University Third Hospital from March 2020 to June 2021 were enrolled.Patients'demographics,routine laboratory examinations,APACHEⅡscore that within 24 hours of admission were obtained from their electronic medical records.The prognosis during the hospitalization and one year after discharge were collected,retrospectively.Univariate and multivariate analysis of prognostic factors were performed.And Kaplan-Meier survival curves were used to examine overall survival.Results A total of 116 elderly patients met inclusion criteria,55 were alive and 61 were died.On univariate analysis,clinical variables such as lactic acid[Lac,hazard ratio(HR)=1.16,95%confidence interval(95%CI)was 1.07-1.26,P<0.001],PCT(HR=1.02,95%CI was 1.01-1.04,P<0.001),alanine aminotransferase(ALT,HR=1.00,95%CI was 1.00-1.00,P=0.143),aspartate aminotransferase(AST,HR=1.00,95%CI was 1.00-1.01,P=0.014),lactate dehydrogenase(LDH,HR=1.00,95%CI was 1.00-1.00,P<0.001),hydroxybutyrate dehydrogenase(HBDH,HR=1.00,95%CI was 1.00-1.00,P=0.001),creatine kinase(CK,HR=1.00,95%CI was 1.00-1.00,P=0.002),MB isoenzyme of creatine kinase(CK-MB,HR=1.01,95%CI was 1.01-1.02,P<0.001),Na(HR=1.02,95%CI was 0.99-1.05,P=0.183),blood urea nitrogen(BUN,HR=1.02,95%CI was 0.99-1.05,P=0.139),fibrinogen(FIB,HR=0.85,95%CI was 0.71-1.02,P=0.078),neutrophil ratio(NEU%,HR=0.99,95%CI was 0.97-1.00,P=0.114),platelet count(PLT,HR=1.00,95%CI was 0.99-1.00,P=0.108)and total bile acid(TBA,HR=1.01,95%CI was 1.00-1.02,P=0.096)shown to be associated with poor prognosis.On multivariable analysis,level of PCT was an important factor influencing the outcome of sepsis(HR=1.03,95%CI was 1.01-1.05,P=0.002).Kaplan-Meier survival curve showed that there was no significa

关 键 词：降钙素原 急性生理学与慢性健康状况评分Ⅱ 老年 脓毒症 预后 生存率 

分 类 号：R459.7[医药卫生—急诊医学]