应激性高血糖联合SOFA评分对脓毒症患者的预后价值  

Prognostic Value of Stress Hyperglycemia Combined with SOFA Score in Patients with Sepsis

作　　者：梁旭 库尔班江·吐尔逊[1] LIANG Xu;Kuerbanjiang·Tuerxun(Department of Emergency Medicine,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,Xinjiang,China)

机构地区：[1]新疆医科大学第二附属医院急诊科,新疆乌鲁木齐830000

出　　处：《医学信息》2023年第21期52-56,共5页Journal of Medical Information

摘　　要：目的探讨应激性高血糖联合SOFA评分对脓毒症患者的预后价值。方法选取2015年7月-2022年7月在新疆医科大学第二附属医院重症医学科收治的176例脓毒症患者,入院后完善血糖及血常规等实验室检查,并进行SOFA评分。所有患者随访28 d,根据患者是否存活分为生存组(72例)和死亡组(104例),比较两组应激性高血糖及SOFA评分,单因素和多因素Logistic回归分析临床基本资料,确定脓毒症患者死亡的独立影响因素;Spearman相关性分析应激性高血糖及SOFA评分与脓毒症患者死亡的相关性;利用受试者工作特征(ROC)曲线评估应激性高血糖、SOFA评分及两者联合检测对脓毒症患者死亡风险的预测价值。结果脓毒症患者病死率为59.09%。死亡组应激性高血糖、SOFA评分均高于生存组,差异有统计学意义(P<0.05)。单因素Logistic回归分析显示,年龄(OR=1.020,95%CI:1.003~1.037)、住院天数(OR=0.953,95%CI:0.919~0.988)、机械通气(OR=0.152,95%CI:0.077~0.299)、血管活性药(OR=19.400,95%CI:7.897~47.660)、应激性高血糖(OR=1.239,95%CI:1.105~1.389)、SOFA评分(OR=1.772,95%CI:1.509~2.081)是脓毒症患者死亡的危险因素。多因素Logistic回归分析显示,SOFA评分(OR=1.603,95%CI:1.322~1.943)、应激性高血糖(OR=1.162,95%CI:1.009~1.309)、血管活性药物(OR=5.092,95%CI:1.062~24.422)是脓毒症患者死亡的独立危险因素。应激性高血糖与SOFA评分呈正相关(rs=0.299)。ROC曲线显示,应激性高血糖、SOFA评分以及两者联合检测预测脓毒症患者死亡的AUC依次为0.713、0.888、0.898。应激性高血糖最佳截断值为11.50 mmol/L时,诊断敏感度为49.00%,特异度为84.70%;SOFA评分最佳截断值为9.00分时,诊断敏感度为83.70%,特异度为86.10%。两者联合检测的敏感度为87.50%,特异度为74.70%。结论应激性高血糖水平升高、SOFA评分升高是脓毒症患者死亡的独立危险因素,两者联合检测对脓毒症患者的预后具有良好的预�Objective To investigate the prognosis of stress hyperglycemia combined with SOFA score in patients with sepsis.Methods A total of 176 patients with sepsis admitted to the Department of Critical Care Medicine,the Second Affiliated Hospital of Xinjiang Medical University from July 2015 to July 2022 were selected.After admission,laboratory tests such as blood glucose and blood routine were improved,and SOFA scores were performed.All patients were followed up for 28 days,and 72 patients in the survival group and 104 patients in the death group were divided according to whether the patients survived.The stress hyperglycemia and SOFA scores were compared between the two groups.The basic clinical data were analyzed by univariate and multivariate Logistic regression analysis to determine the independent influencing factors of death in patients with sepsis.Spearman correlation analysis was used to analyze the correlation between stress hyperglycemia and SOFA score and death in patients with sepsis.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of stress hyperglycemia,SOFA score and their combined detection on the risk of death in patients with sepsis.Results The mortality rate of sepsis patients was 59.09%.The scores of stress hyperglycemia and SOFA in the death group were higher than those in the survival group,and the differences were statistically significant(P<0.05).Univariate logistic regression analysis showed that age(OR=1.020,95%CI:1.003-1.037),hospitalization days(OR=0.953,95%CI:0.919-0.988),mechanical ventilation(OR=0.152,95%CI:0.077-0.299),vasoactive drugs(OR=19.400,95%CI:7.897-47.660),stress hyperglycemia(OR=1.239,95%CI:1.105-1.389),SOFA score(OR=1.772,95%CI:1.509-2.081)were risk factors for death in patients with sepsis.Multivariate Logistic regression analysis showed that SOFA score(OR=1.603,95%CI:1.322-1.943),stress hyperglycemia(OR=1.162,95%CI:1.009-1.309)and vasoactive drugs(OR=5.092,95%CI:1.062-24.422)were independent risk factors for death in patients with sep

关 键 词：应激性高血糖 序贯器官衰竭评分 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]