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作 者:孔田玉[1] 郭苗铃 杨其霖[1] 何薇[1] 蒋芸杰 温德良[1] Kong Tianyu;Guo Miaoling;Yang Qilin;He Wei;Jiang Yunjie;Wen Deliang(Department of Critical Care Medicine,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China;The Second Clinical College of Guangzhou Medical University,Guangzhou 510180,China)
机构地区:[1]广州医科大学附属第二医院重症医学科,广州510260 [2]广州医科大学第二临床学院,广州510180
出 处:《血栓与止血学》2023年第6期254-259,共6页Chinese Journal of Thrombosis and Hemostasis
基 金:广州市科技计划项目(202102010068);广东省自然科学基金(2022A1515010397、2023A1515011988);广州医科大学附属第二医院新技术项目(2020⁃LCYJ⁃XJS⁃08)。
摘 要:目的探讨纤维蛋白原水平与重症监护室(ICU)脓毒症患者住院死亡率之间的关系。方法采用回顾性队列研究,以2017年01月至2023年08月入住本院ICU的3302例脓毒症患者为研究对象。根据纤维蛋白原的三分位数分组,分为:低纤维蛋白原组(<2.64 g/L),中间纤维蛋白原组(2.64~4.08 g/L),高纤维蛋白原组(>4.08 g/L)。采用限制性立方样条模型以及Cox比例风险模型来评估纤维蛋白原水平与住院死亡率的关系,并运用Kaplan-Meier方法绘制不同纤维蛋白原水平下的生存曲线。结果在调整相关危险因素后,纤维蛋白原水平与脓毒症患者住院死亡率呈非线性关系。和中间纤维蛋白原组相比,低纤维蛋白原组调整后的HR=1.213(95%CI为1.019~1.442,P<0.05)。高纤维蛋白原组在调整后HR=1.087(95%CI为0.916~1.289,P>0.05)。结论纤维蛋白原水平与ICU脓毒症患者住院死亡率呈非线性关系,低的纤维蛋白原水平与住院死亡率升高有关,但高的纤维蛋白原水平对住院死亡率的影响不大。Objective To investigate the relationship between fibrinogen levels and in-hospital mortality in patients with sepsis in the intensive care unit(ICU).Methods A retrospective cohort study was performed on 3302 patients with sepsis admitted to the ICU of our hospital from January 2017 to August 2023.Based on the tertiles grouping of fibrinogen levels,patients were divided into three groups,i.e.,:low fibrinogen group(<2.64 g/L),intermediate fibrinogen group(2.64~4.08 g/L),and high fibrinogen group(>4.08 g/L).Restricted cubic spline model and Cox proportional risk model were used to assess the relationship between fibrinogen level and in-hospital mortality,and the Kaplan-Meier method was used to plot the survival curves at different fibrinogen levels.Results Fibrinogen levels were non-linearly associated with in-hospital mortality in patients with sepsis after adjustment for relevant risk factors.Compared with the intermediate fibrinogen group,the adjusted HR(95%CI)in the low fibrinogen group was 1.213(95%CI was from 1.019 to 1.442),P<0.05.In the high fibrinogen group,the adjusted HR was 1.087(95%CI was from 0.916 to 1.289),P>0.05.Conclusion Fibrinogen levels showed a non-linear relationship with in-hospital mortality in ICU sepsis patients,with low fibrinogen levels associated with increased in-hospital mortality but high fibrinogen levels having little effect on in-hospital mortality.
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