重症监护室脓毒症相关性心肌损伤患者28 d病死率的危险因素  

Risk factors for 28-day mortality in patients with sepsis related myocardial injury in the intensive care unit

作　　者：张翠翠 亓志玲[2] 孙强[2] 胡庆河[2] 郝翠平[2] 牛芳 尉希清 Zhang Cuicui;Qi Zhiling;Sun Qiang;Hu Qinghe;Hao Cuiping;Niu Fang;Wei Xiqing(Clinical Medical College,Jining Medical University,Jining 272067,China;Department of Critical Medicine,Affiliated Hospital of Jining Medical University,Jining 272030,China;Heart Failure Ward,Department of Cardiology,Affiliated Hospital of Jining Medical University,Jining 272030,China)

机构地区：[1]济宁医学院临床医学院,济宁272067 [2]济宁医学院附属医院重症医学科,济宁272030 [3]济宁医学院附属医院心内科,济宁272030

出　　处：《中国医师杂志》2023年第8期1165-1169,共5页Journal of Chinese Physician

基　　金：山东省医药卫生科技发展计划项目(2018WSB34007);山东省济宁市重点研发计划软科学项目(2021JNZC016)。

摘　　要：目的分析并探究影响脓毒症相关性心肌损伤患者28 d病死率的独立危险因素。方法采用回顾性队列研究,收集2015年1月至2020年12月济宁医学院附属医院重症医学科(ICU)收治的505例诊断为脓毒症相关性心肌损伤患者的临床资料。根据患者28 d生存情况将患者分为生存组和死亡组,采用COX多因素回归分析脓毒症相关性心肌损伤患者28 d病死率的影响因素,并绘制受试者工作特征(ROC)曲线评估各独立危险因素预测脓毒症相关性心肌损伤患者28 d病死率的效能。结果共纳入505例脓毒症相关性心肌损伤患者,其中28 d生存282例,死亡223例,病死率为44.16%。COX多因素回归分析显示:序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、血乳酸(LAC)、氧合指数(PaO_(2)/FiO_(2))、入室心率和白蛋白均是脓毒症相关性心肌损伤患者28 d病死率的独立危险因素(均P<0.05)。ROC曲线分析显示,SOFA评分[ROC曲线下面积(AUC)为0.7662,95%可信区间(95%CI)为0.7245~0.8079]对脓毒症相关性心肌损伤患者28 d死亡的预测价值优于APACHEⅡ评分、LAC、PaO_(2)/FiO_(2)、入室心率和白蛋白[AUC分别为0.7541(0.7115~0.7967)、0.7526(0.7101~0.7951)、0.6970(0.6497~0.7442)、0.6232(0.5737~0.6727)、0.6203(0.5708~0.6697)]。结论SOFA评分、APACHEⅡ评分、LAC、PaO_(2)/FiO_(2)、入室心率和白蛋白是脓毒症相关性心肌损伤28 d病死率的独立危险因素,临床应早期识别这些因素,早期干预,改善患者预后。Objective To analyze and explore the independent risk factors of 28-day mortality in patients with septic myocardial injury.Methods A retrospective cohort study was conducted to collect clinical data of 505 patients diagnosed with sepsis related myocardial injury admitted to the intensive care unit(ICU)of the Affiliated Hospital of Jining Medical University from January 2015 to December 2020.According to the 28-day survival status of patients,they were divided into survival group and death group.COX multivariate regression analysis was used to analyze the influencing factors of the 28-day mortality rate of sepsis related myocardial injury patients,and receiver operating characteristic(ROC)curves were drawn to evaluate the effectiveness of independent risk factors in predicting the 28-day mortality rate of sepsis related myocardial injury patients.Results A total of 505 patients with sepsis myocardial injury were included,of which 282 survived on 28 days and 223 died,with a mortality rate of 44.16%.COX multivariate regression analysis showed that Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,blood lactate(LAC),oxygenation index(PaO_(2)/FiO_(2)),admission heart rate,and albumin were independent risk factors for sepsis associated myocardial injury mortality at 28 days(all P<0.05).ROC curve analysis showed that the area under the ROC curve(AUC)of SOFA score was 0.7662,and the 95%confidence interval(95%CI)was 0.7245-0.8079;The predictive value of 28-day mortality in sepsis associated myocardial injury patients was superior to APACHEⅡscore,LAC,PaO_(2)/FiO_(2),admission heart rate,and albumin[The AUC values were 0.7541(0.7115-0.7967),0.7526(0.7101-0.7951),0.6970(0.6497-0.7442),0.6232(0.5737-0.6727),and 0.6203(0.5708-0.6697),respectively].Conclusions SOFA score,APACHEⅡscore,LAC,PaO_(2)/FiO_(2),admission heart rate,and albumin are independent risk factors for the 28-day mortality rate of sepsis related myocardial injury.Clinical practice should identif

关 键 词：重症监护病房 脓毒症 心肌损伤 死亡率 

分 类 号：R459.7[医药卫生—急诊医学] R542.2[医药卫生—治疗学]