实验室衰弱指数对老年CAP住院患者并发脓毒症及脓毒性休克风险的预测价值  

The predictive value of laboratory frailty index for the risk of sepsis and septic shock in elderly CAP inpatients

作　　者：任燕 陈善萍 周莉华[1] 王凌霄 管丽娟[1] 杨永学[1] REN Yan;CHEN Shanping;ZHOU Lihua;WANG Lingxiao;GUAN Lijuan;YANG Yongxue(Department of Geriatrics,Chengdu Fifth People's Hospital(The Second Clinical Medical College,Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine),Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu,Chengdu 611137,China)

机构地区：[1]成都市第五人民医院(成都中医药大学附属第五人民医院/第二临床医学院)老年医学科,成都市老年疾病研究所/成都市肿瘤防治所,611137

出　　处：《天津医药》2024年第4期416-421,共6页Tianjin Medical Journal

基　　金：四川省医学青年创新科研课题计划项目(Q19036)。

摘　　要：目的 探讨实验室衰弱指数(FI-LAB)对老年社区获得性肺炎(CAP)住院患者发生脓毒症及脓毒性休克风险的预测价值。方法 回顾性纳入住院的老年CAP患者502例。选取40个入院后24 h内首次采集的常规实验室指标和生命体征指标构建FI-LAB,FI-LAB<0.35为非衰弱组,FI-LAB≥0.35为衰弱组。判定脓毒症和脓毒性休克的发生情况。采用修正Poisson回归构建预测模型并采用受试者工作特征(ROC)曲线分析预测价值。结果 多因素修正Poisson回归分析显示衰弱是老年CAP并发脓毒症和脓毒性休克的危险因素(P<0.001)。将FI-LAB乘以100后纳入多因素修正Poisson回归分析,发现FI-LAB每增加0.01,发生脓毒症及脓毒性休克的风险分别增高5.9%和6.2%(均P<0.001)。FI-LAB预测脓毒症及脓毒性休克的ROC曲线下面积分别为0.865和0.850,最佳截断值分别为0.28和0.42。结论 衰弱增加CAP并发脓毒症及脓毒性休克的风险。FI-LAB可预测CAP患者发生脓毒症和脓毒性休克的风险,早期发现高危人群。Objective To investigate the value of laboratory frailty index(FI-LAB)in predicting the risk of sepsis and septic shock in elderly hospitalized patients with community-acquired pneumonia(CAP).Methods A total of 502 elderly CAP patients hospitalized in Chengdu Fifth People's Hospital were retrospectively included.Forty routine laboratory indexes and vital signs collected for the first time within 24 hours after admission were selected to construct FI-LAB.Patients with FI-LAB≥0.35 were defined as the frail group,while patients with FI-LAB<0.35 were defined as the non-frail group.The occurrence of sepsis and septic shock was observed.The predictive model was established by modified Poisson regression,and the predictive value was analyzed by the ROC curve of the subjects.Results Multivariate modified Poisson regression analysis showed that frailty was a risk factor for sepsis(P<0.001)and septic shock(P=0.001)in elderly patients with CAP(P<0.001).When FI-LAB was multiplied by 100 and included in the multivariate Poisson regression analysis,it was found that for every 0.01 increase in FI-LAB,the risk of sepsis and septic shock increased by 5.9%and 6.2%(both P<0.001).The area under ROC curve of FI-LAB for predicting sepsis and septic shock was 0.865 and 0.850(both P<0.001),respectively,and the best cut-off values were 0.28 and 0.42,respectively.Conclusion Frailty increases the risk of CAP complications with sepsis and septic shock.FI-LAB can predict the risk of sepsis in CAP patients and detect high-risk groups early.

关 键 词：脓毒症 休克 脓毒性 肺炎 老年人 衰弱指数 

分 类 号：R592[医药卫生—老年医学]