雌二醇联合SOFA评分对老年尿源性脓毒症妇女并发谵妄的预测价值  

Predictive value of serum estradiol combined with sequential organ failure assessment score for concurrent delirium in elderly women with urosepsis

作　　者：杨妹 吴燕丽 邢柏[1] Yang Mei;Wu Yanli;Xing Bo(Department of Emergency,Donghu Branch of the Second Affliated Hospital of Hainan Medical University,Haikou 570203,China)

机构地区：[1]海南医学院第二附属医院东湖分院急诊科,海口570203

出　　处：《国际泌尿系统杂志》2023年第3期385-389,共5页International Journal of Urology and Nephrology

基　　金：海南省自然科学资金项目(819MS128)。

摘　　要：目的探讨血清雌二醇(E2)联合序贯器官衰竭估计(SOFA)评分对老年尿源性脓毒症妇女并发谵妄的预测价值。方法选取2019年1月至2021年8月在本院重症监护室(ICU)收治的230例老年尿源性脓毒症妇女,根据是否出现谵妄将其分为谵妄组(75例)和非谵妄组(155例)。比较两组患者入组时的一般资料、SOFA评分、急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分以及血清性激素[促卵泡激素(FSH)、黄体生成素(LH)、血清E2]水平。采用Spearson相关分析确定血清E2水平与SOFA评分、APACHEⅡ评分的相关性。采用多因素logistic回归模型分析老年尿源性脓毒症妇女并发谵妄的影响因素。绘制受试者工作特征(ROC)曲线,采用曲线下面积(AUC)评价各指标对老年尿源性脓毒症妇女并发谵妄的预测价值。结果谵妄组的年龄、脑卒中史、机械通气比例、SOFA评分、APACHEⅡ评分、ICU停留时间以及28 d病死率均高于非谵妄组,差异均有统计学意义(均P<0.05)。与非谵妄组比较,谵妄组的血清E2、降钙素原、血乳酸水平明显升高,差异均有统计学意义(均P<0.05)。Spearson相关分析结果显示,血清E2水平与SOFA评分和APACHEⅡ评分呈显著正相关(r=0.297、0.269,均P<0.001)。多因素logistic回归分析结果显示,机械通气、SOFA评分以及血清E2水平为老年尿源性脓毒症妇女并发谵妄的独立危险因素(均P<0.05)。ROC曲线分析结果显示,血清E2、SOFA评分单独预测老年尿源性脓毒症妇女并发谵妄的AUC分别为0.795(95%CI:0.737~0.845)、0.822(95%CI:0.766~0.869),两者联合预测的AUC可提高到0.883(95%CI:0.834~0.962),两者的预测截断值分别为34.58 ng/L、9分。结论血清E2和SOFA评分值升高是老年尿源性脓毒症妇女并发谵妄的独立危险因素,两指标联合检测可提高对老年尿源性脓毒症妇女并发谵妄的预测效能。Objective To investigate the predictive value of serum estradiol(E2)combined with sequential organ failure assessment(SOFA)score for concurrent delirium in elderly women with urosepsis.Methods A total of 230 elderly women with urosepsis admitted to the intensive care unit(ICU)of our hospital from January 2019 to August 2021 were selected.According to the presence or absence of delirium,they were divided into delirium group(75 cases)and non-delirium group(155 cases).The general data,SOFA score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,and the serum levels of sex hormones,including follicle stimulating hormone(FSH),luteinizing hormone(LH),serum E2 were compared between the two groups.Spearson correlation analysis was used to identify the correlation between the serum levels of E2 and SOFA score,APACHEⅡscore.A multivariate logistic regression model analysis was used to investigate the influencing factors of concurrent delirium in elderly women with urosepsis.A receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the predictive value of each index for concurrent delirium in elderly women with urosepsis.Results The age,proportion of patients with stroke history,proportion of mechanical ventilation,SOFA score,APACHEⅡscore,length of ICU stay and 28-day mortality in delirium group were higher than those in non-delirium group,and the differences were statistically significant(all P<0.05).Spearson correlation analysis showed that serum E2 level was significantly positively correlated with SOFA score and APACHEⅡscore(r=0.297、0.269,all P<0.001).Multivariate logistic regression analysis showed that mechanical ventilation,SOFA score and elevated serum E2 level were independent risk factors for delirium in elderly women with urosepsis(all P<0.05).ROC curve analysis showed that the AUC of serum E2 and SOFA score alone in predicting delirium in elderly women with urosepsis was 0.795(95%CI:0.737-0.845)and 0.822(95%CI:0.766-0.869),respectiv

关 键 词：脓毒症 妇女 谵妄 雌二醇 器官功能障碍评分 

分 类 号：R459.7[医药卫生—急诊医学] R749.1[医药卫生—治疗学]