血浆NGAL联合乳酸检测对老年脓毒症患者预后的评估价值  

Evaluation value of plasma NGAL combined with lactic acid detection on prognosis in elderly patients with sepsis

作　　者：张巍 吴颖 党宗彦 肖烽 何再明 ZHANG Wei;WU Ying△;DANG Zongyan;XIAO Feng;HE Zaiming(Department of Emergency Medicine,Putuo District Liqun Hospital,Shanghai 200333,China)

机构地区：[1]上海市普陀区利群医院急诊医学科,上海200333

出　　处：《检验医学与临床》2023年第12期1726-1729,1735,共5页Laboratory Medicine and Clinic

基　　金：上海市普陀区卫生系统自主创新科研资助项目(ptkwwws201720)。

摘　　要：目的探讨血浆中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平对老年脓毒症患者预后的评估价值。方法选择2020年1月至2021年12月该院急诊医学科诊治的符合脓毒症诊断的老年患者112例作为研究对象。根据28 d预后情况分为死亡组与存活组,分析两组患者入院时、入院24 h、入院48 h血浆NGAL水平,比较两组基线资料,采用多因素Logistic回归分析老年脓毒症患者死亡的影响因素,采用受试者工作特征(ROC)曲线分析血浆NGAL及其他筛选出的因素对老年脓毒症患者死亡的诊断价值。结果死亡组入院时、入院24 h、入院48 h的血浆NGAL水平均高于存活组(P<0.05)。年龄、降钙素原(PCT)水平、乳酸水平、全身性感染相关性器官功能衰竭(SOFA)评分在死亡组与存活组间差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示入院时血浆NGAL、乳酸水平是脓毒症患者28 d死亡的独立影响因素(P<0.05)。ROC曲线分析显示:老年脓毒症患者入院时乳酸、血浆NGAL水平单项以及联合检测预测老年脓毒症患者死亡的曲线下面积(AUC)分别为0.875(95%CI:0.803~0.947)、0.863(95%CI:0.789~0.937)、0.898(95%CI:0.833~0.962),联合检测预测老年脓毒症患者死亡的灵敏度和特异度则分别为0.875和0.863。结论血浆NGAL对老年脓毒症患者预后,特别是28 d死亡风险的评估有一定的临床价值,血浆NGAL和乳酸联合检测的评估价值更高。Objective To investigate the evaluation value of plasma neutrophil gelatinase associated lipid transporter(NGAL)level on the prognosis in elderly patients with sepsis.Methods A total of 112 elderly patients diagnosed as sepsis and treated in the department of emergency medicine in this hospital from January 2020 to December 2021 were selected as the study subjects and divided into the death group and survival group according to the 28 d prognosis.The plasma NGAL levels at admission,24 h,48 h after admission in the two groups were analyzed,and the baseline data were compared between the two groups.The multivariate Logistic regression was used to analyze the influencing factors of mortality in elderly patients with sepsis.The diagnostic value of plasma NGAL and other screened factors for mortality in elderly patients with sepsis was analyzed by using the receiver operating characteristic(ROC)curve.Results The plasma NGAL levels at admission,24 h and 48 h after admission in the death group were higher than those in the survival group(P<0.05).The age,levels of calcitonin(PCT)and lactic acid,and the score of systemic infection related organ failure(SOFA)were statistically significantly different between the death group and the survival group(P<0.05).The multivariate Logistic regression analysis results showed that plasma NGAL and lactic acid levels at admission were the independent influencing factors for the 28 d mortality in the patients with sepsis(P<0.05).The ROC curve analysis showed that the areas under the curve(AUC)of the levels of lactic acid,plasma NGAL of single item and their combined detection for diagnosing the death in elderly patients with sepsis were 0.875(95%CI:0.803-0.947),0.863(95%CI:0.789-0.937),and 0.898(95%CI:0.833-0.962)respectively.The sensitivity and specificity of combined detection for diagnosing the death in elderly patients with sepsis were 0.875 and 0.863 respectively.Conclusion Plasma NGAL has certain clinical value in the prognosis of elderly patients with sepsis,especially in the eval

关 键 词：脓毒症 血浆中性粒细胞明胶酶相关脂质运载蛋白 乳酸 预后 

分 类 号：R446.11[医药卫生—诊断学]