血乳酸、IL-6联合SOFA评分对脓毒症患者28 d死亡风险的预测价值  

Predictive value of blood lactate and IL-6 combined with SOFA score on the risk of death at 28 d in patients with sepsis

作　　者：梁旭 李国旗 张红玉[2] 库尔班江·吐尔逊[1] LIANG Xu;LI Guoqi;ZHANG Hongyu;Kuerbanjiang·TUERXUN(Department of Emergency Medicine,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,Xinjiang,China;Department of Critical Care 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 [2]新疆医科大学第二附属医院重症医学科,新疆乌鲁木齐830000

出　　处：《暨南大学学报（自然科学与医学版）》2024年第1期43-50,共8页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：新疆维吾尔自治区自然科学基金资助项目(2021D01C361)。

摘　　要：目的:探讨血乳酸、IL-6联合序贯器官衰竭评估(SOFA)对脓毒症患者28 d死亡风险的预测价值。方法:回顾性分析2015年7月至2023年7月新疆医科大学第二附属医院重症医学科收治的145例脓毒症患者的临床资料,所有患者入院后完善血气分析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46例和死亡组99例,比较两组血乳酸、IL-6及SOFA评分的区别,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相关性分析血乳酸、IL-6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)曲线评估血乳酸、IL-6、SOFA评分及三者联合检测对脓毒症患者死亡风险的预测价值。最后,基于R语言采用Bootstrap法对模型重抽样500次后,绘制校准曲线及临床决策曲线。结果:脓毒症死亡组患者血乳酸水平、IL-6及SOFA评分均明显高于生存组,差异均具有统计学意义(P<0.05)。脓毒症患者病死率为68%(99/145)。单因素Logistic回归分析显示,糖尿病、血乳酸、IL-6、SOFA评分是导致脓毒症患者死亡的相关因素。多因素Logistic回归分析显示,高SOFA评分、有糖尿病、高血乳酸、高IL-6是导致脓毒症患者死亡的独立危险因素。血乳酸、IL-6、SOFA评分与脓毒症患者死亡呈正相关,ROC曲线分析结果表明,血乳酸、IL-6、SOFA评分及三者联合检测预测脓毒症患者死亡的AUC依次为0.863、0.850、0.897、0.949。血乳酸最佳截断值为2.950 mmol/L时,诊断敏感度为77.800%,特异度为89.100%;IL-6最佳截断值为100.970 pg/mL时,诊断敏感度为70.700%,特异度91.300%;SOFA评分最佳截断值为7.500分时,诊断敏感度为93.900%,特异度为80.400%;三者联合检测的敏感度为90.900%,特异度为89.100%。结论:血乳酸、IL-6、SOFA评分升高是脓毒症患者死亡的独立危险因素,此次构建的临床预测模型的准确�Objective:The aim of this study was to investigate the predictive value of blood lactate,interleukin-6(IL-6),and the sequential organ failure assessment(SOFA)score on the 28-day mortality risk in sepsis patients.Methods:Retrospective analysis of clinical data of 145 sepsis patients admitted to the Department of Critical Care Medicine at the Second Affiliated Hospital of Xinjiang Medical University.All patients were admitted to the hospital and laboratory tests such as blood gas analysis and routine blood tests were completed and SOFA scores were performed.All patients were followed up for 28 days.Based on survival outcome,the patients were divided into two groups:the survival group(46 cases)and the death group(99 cases).Comparative analysis was then carried out to assess the differences in blood lactate,IL-6,and SOFA scores between the two groups.Univariate and multivariate logistic regression analyses were performed to identify independent factors influencing sepsis patient mortality.Spearman correlation analysis was employed to examine the associations between blood lactate,IL-6,SOFA scores,and sepsis patient mortality.Furthermore,the predictive value of blood lactate,IL-6,and SOFA scores,as well as their combined tests,were evaluated using receiver operating characteristic(ROC)curves.The model underwent 500 resampling iterations using the Bootstrap method in R,followed by the generation of calibration curves and clinical decision curves.Results:Blood lactate levels,IL-6 and SOFA scores of patients in the sepsis death group were significantly higher than those in the survival group,and the differences were all statistically significant(P<0.05).The overall morbidity and mortality rate among patients with sepsis was 68%(99/145).Univariate logistic regression analysis shows diabetes,blood lactate,IL-6,and SOFA score as correlates of death in patients with sepsis.Multivariable logistic regression analysis revealed that high SOFA score,having diabetes mellitus,and high IL-6 were independent risk factors for death in

关 键 词：血乳酸 IL-6 序贯器官衰竭评估(SOFA) 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]