预后营养指数联合乳酸及病原菌对急诊老年血流感染患者的预后评估  

Predictive value of prognostic nutritional index combined with blood lactic acid and pathogen in elderly patients with bloodstream infection in emergency department

作　　者：孙晏 赵永祯 夏东[1] 胡文辉[1] 田卫华 Sun Yan;Zhao Yongzhen;Xia Dong;Hu Wenhui;Tian Weihua(Emergency Department of Beijing Geriatric Hospital,Beijing 100095,China)

机构地区：[1]北京老年医院急诊急救部,北京100095

出　　处：《中国急救医学》2023年第7期551-556,共6页Chinese Journal of Critical Care Medicine

基　　金：北京市医院管理中心临床医学发展专项经费(ZYLX202131);北京老年医院青年优才项目。

摘　　要：目的分析预后营养指数(prognostic nutritional index,PNI)、血乳酸及病原菌对急诊老年血流感染(blood stream infection,BSI)患者预后的预测价值。方法采用回顾性分析方式,纳入北京老年医院急诊科2021年6月至2022年5月的BSI患者共103例。对样本资料进行收集,包括基础病、感染部位、病原菌种类、实验室指标及临床评分等,按患者临床结局分为死亡组和好转组,比较两组间各指标差异,分析患者住院死亡的相关危险因素及其预测价值。结果急诊老年BSI患者以革兰阴性菌感染为主(54.4%),但死亡患者中革兰阳性菌感染比例更高(66.7%)。急诊老年BSI患者中,死亡组革兰阳性菌感染、意识改变、血小板计数、血乳酸、早期预警评分(modified early warning score,MEWS)及序贯器官衰竭评分(sequential organ failure assessment,SOFA)高于好转组,白蛋白、前白蛋白及PNI低于好转组,差异均有统计学意义(P<0.05)。其中病原菌(革兰阳性菌感染)、血乳酸、PNI及SOFA评分为急诊老年BSI患者死亡的独立危险因素(P<0.05)。病原菌、血乳酸、PNI及三者联合预测急诊老年BSI患者住院死亡受试者工作特征(ROC)曲线下面积(AUC)分别为0.637、0.747、0.651及0.838,SOFA评分的AUC为0.685,SOFA评分与前三者联合评估预后时的曲线下面积为0.875。结论革兰阳性菌感染、血乳酸及PNI为急诊老年BSI患者住院死亡的独立危险因素,三者联合对患者的住院死亡有一定的预测价值,与SOFA评分联用可能进一步提高对预后的评估能力。Objective To investigate the predictive value of the prognostic nutritional index(PNI),blood lactic acid and pathogen in elderly patients with bloodstream infection(BSI)admitted to emergency department(ED).Methods A total of 103 elderly patients with BSI admitted to ED of Beijing Geriatric Hospital from June 2021 to May 2022 were involved in the study.A series of items including sex,age,underlying diseases,site of infection,pathogens,laboratory examination and clinical assessment scores were collected.According to their outcomes,the patients were divided into the death group and the improved group.Each item between the two groups was compared and multivariate Logistic regression was used to find the independent risk factors of death.Results Gram-negative bacteria were the main pathogen in elderly patients with BSI(54.4%),but the proportion of gram-positive bacteria infection was higher in the dead patients(66.7%).In the elderly patients with BSI,the infection of gram-positive bacteria,abnormal consciousness,platelet count,blood lactic acid,modified early warning score(MEWS)and sequential organ failure assessment(SOFA)in the death group were higher than those in the improved group,while the levels of albumin,prealbumin and PNI in the death group were lower than those in the improved group(P<0.05).The pathogen(infection of gram-positive bacteria),blood lactic acid,PNI and SOFA were the independent risk factors of death in elderly patients with BSI in ED(P<0.05).The area under ROC curve(AUC)of pathogen,blood lactic acid,PNI and their combination for predicting the death in elderly patients with BSI was 0.637,0.747,0.651 and 0.838,respectively.The AUC of SOFA was 0.685,and the AUC was 0.875 when combined with the former three items.Conclusions The pathogen(infection of gram-positive bacteria),blood lactic acid,PNI are the independent risk factors of in-hospital death in elderly patients with BSI.The combination of pathogen,blood lactic acid and PNI had certain predictive value for in-hospital death,combining with SOF

关 键 词：急诊 老年 血流感染(BSI) 预后营养指数(PNI) 乳酸 预后 病原菌 序贯器官衰竭评分(SOFA) 

分 类 号：R459.7[医药卫生—急诊医学]