总甲状腺素联合D-二聚体、尿酸预测老年脓毒性休克病人28 d预后的价值  

Value of total tetraiodothyronine combined with D-dimeRand uric acid in predicting the 28-d prognosis in elderly patients with septic shock

作　　者：张剑 李全瑞[1] 田耕[1] ZHANG Jian;LI Quan-rui;TIAN Geng(Department of Infection,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院感染性疾病科,北京市100053

出　　处：《实用老年医学》2023年第8期815-818,共4页Practical Geriatrics

摘　　要：目的探索总甲状腺素(TT4)联合D-二聚体、尿酸预测老年脓毒性休克病人28 d天预后的价值。方法采用回顾性研究方法,收集我院住院的老年脓毒性休克病人的临床资料,根据28 d预后分为生存组(46例)和死亡组(32例)。应用多因素Logistic回归分析影响预后的危险因素并建立预测模型,计算模型的区分度和校准度;应用AUC比较预测模型和序贯器官功能衰竭评估(SOFA)评分预测病人预后的价值。结果Logistic回归显示,TT4、D-二聚体和尿酸是影响老年脓毒性休克病人28 d预后的独立危险因素(P<0.05),预测模型Y=-3.811-0.553×TT4+0.289×D-二聚体+0.013×尿酸;模型的灵敏度为91.67%,特异度为94.12%,区分度为0.961,校准度曲线R2=0.991,P=0.887,AUC为0.961(95%CI:0.889~0.991),大于SOFA评分的AUC 0.833(95%CI:0.706~0.959)(P<0.05)。结论TT4联合D-二聚体、尿酸对老年脓毒性休克病人28 d预后有较好的预测价值。Objective To explore the value of total tetraiodothyronine(TT4)combined with D-dimeRand uric acid in predicting the 28-d prognosis in the elderly patients with septic shock.Methods A retrospective study was conducted to collect the clinical data of the elderly patients with septic shock.According to the 28-d prognosis,all patients were divided into survival group(46 cases)and death group(32 cases).Multivariate Logistic regression was used to analyze the risk factors of prognosis.A prediction model was established,and the discrimination and calibration of the model were calculated;ReceiveRoperatoRcharacteristic(ROC)curve was used to assess the predictive value of the prediction model and the Sequential Organ Failure Assessment(SOFA)score.Results Logistic regression showed TT4,D-dimeRand uric acid were the independent risk factors of the 28-d prognosis in the elderly patients with septic shock(P<0.05)and a predictive model was established:Y=-3.811-0.553×TT4+0.289×D-dimer+0.013×uric acid.ROC curve showed that the sensitivity and specificity of the predictive model was 91.67%,94.12%,respectively,with discrimination of 0.961,calibration curve R2=0.991(P=0.887).The area undeRthe ROC curve(AUC)of the model foRpredicting the prognosis was 0.961(95%CI:0.889-0.991),which was higheRthan that of SOFA score(AUC=0.833,95%CI:0.706-0.959)(P<0.05).Conclusions TT4-related prediction model has a good predictive value foRthe 28-d prognosis in the elderly patients with septic shock.

关 键 词：总甲状腺素 老年人 脓毒性休克 预后 

分 类 号：R459.7[医药卫生—急诊医学]