序贯器官衰竭评分、血清超敏C反应蛋白及D二聚体与脓毒症所致急性呼吸窘迫综合征患者预后的相关分析  

Correlation analysis of SOFA score,serum hs-CRP,D-dimer and prognosis of patients with sepsis-induced acute respiratory distress syndrome

作　　者：袁法伟[1] 刘栋 Yuan Fawei;Liu Dong(Department of Intensive Care Unit,Huangshi Central Hospital,Affiliated Hospital of Hubei Polytechnic University,Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention,Huangshi 435000,Hubei,China)

机构地区：[1]湖北省黄石市中心医院、湖北理工学院附属医院重症医学科、肾脏疾病发生与干预湖北省重点实验室,黄石435000

出　　处：《中国综合临床》2024年第3期196-201,共6页Clinical Medicine of China

摘　　要：目的探讨序贯器官衰竭评分(sequential organ failure score,SOFA)及血清超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、D二聚体与脓毒症所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者预后的相关性及其联合预测效果。方法选取2019年5月至2022年5月湖北省黄石市中心医院重症医学科诊治的76例脓毒症并发ARDS患者作为研究对象进行回顾性分析,并根据入院后28 d预后情况分为死亡组(24例)与存活组(52例)。对比SOFA评分及hs-CRP、D二聚体水平。符合正态分布的计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ^(2)检验;采用二元Logistic回归模型分析影响脓毒症所致ARDS患者预后的危险因素,并根据Logistic回归分析结果构建SOFA评分、hs-CRP、D二聚体三项联合预测脓毒症并发ARDS模型,采用ROC曲线分析模型预测效能。结果死亡组患者的SOFA评分为(6.63±1.91)分、hs-CRP为(108.82±30.71)mg/L、D二聚体为(5.17±1.53)mg/L,存活组分别为(4.04±1.33)分、(71.11±18.18)mg/L、(3.08±0.60)mg/L,两组比较差异均有统计学意义(t值分别为6.84、6.70、8.57,均P<0.001)。二元Logistic回归分析显示,SOFA评分(OR=2.671,95CI 1.726~4.135,P<0.001)、hs-CRP(OR=1.080,95CI 1.038~1.123,P<0.001)、D二聚体(OR=5.491,95CI 2.499~12.069,P<0.001)水平升高是影响脓毒症所致ARDS患者预后的独立危险因素。ROC曲线分析显示,SOFA评分、hs-CRP、D二聚体及三项联合预测脓毒症所致ARDS患者预后的AUC值分别为0.847、0.833、0.867、0.978,均P<0.001;敏感度分别为75.00%、62.50%、75.00%、87.50%;特异度分别为88.50%、98.10%、98.10%、96.20%。结论SOFA评分及血清hs-CRP、D二聚体水平会随着脓毒症患者并发ARDS而升高,动态监测其变化能为预后评估提供重要参考。Objective To explore the correlation between sequential organ failure score(SOFA),serum high-sensitivity C-reactive protein(hs-CRP),D-dimer and prognosis of sepsis-induced acute respiratory distress syndrome(ARDS)patients and their joint prediction effect.Methods Clinical data of 76 patients with sepsis complicated with ARDS diagnosed and treated in Department of Intensive Care Unit,Huangshi Central Hospital from May 2019 to May 2022 were retrospectively analyzed,and were divided into death group(n=24)and survival group(n=52)according to the prognosis 28 days after admission.The SOFA score,hs-CRP and D-dimer levels were compared.Independent sample t-test was used for inter group comparison of metric data that conforms to normal distribution,while χ^(2) test was used for inter group comparison of count data.Binary Logistic regression model was used to analyze the risk factors affecting the prognosis of patients with ARDS caused by sepsis.The ROC curve model was used to analyze the AUC value,sensitivity and specificity of SOFA score,hs-CRP and D-D in predicting death during hospitalization in patients with sepsis complicated with ARDS.Results In the death group,SOFA score was(6.63±1.91),hs-CRP score was(108.82±30.71)mg/L,D-dimer score was(5.17±1.53)mg/L.The survival group was(4.04±1.33),(71.11±18.18)mg/L,and(3.08±0.60)mg/L,respectively,and there were significant differences between the two groups(t=6.84,6.70,8.57,all P<0.001).Binary Logistic regression analysis showed that SOFA score(OR=2.671,95CI 1.726-4.135,P<0.001),hs-CRP(OR=1.080,95CI 1.038-1.123,P<0.001),D-D(OR=5.491,95CI 2.499-12.069,P<0.001)was an independent risk factor for the prognosis of ARDS patients with sepsis.ROC curve analysis showed that the AUC values of SOFA score,hs-CRP,D-dimer and their combination in predicting the prognosis of ARDS patients with sepsis were(0.847,0.833,0.867,0.978,all P<0.001).The sensitivity was 75.00%,62.50%,75.00%,87.50%;the specificity was 88.50%,98.10%,98.10%,96.20%,respectively.The comparison of SOFA score with t

关 键 词：脓毒症 序贯器官衰竭评分 超敏C反应蛋白 D二聚体 急性呼吸窘迫综合征 预后 

分 类 号：R459.7[医药卫生—急诊医学] R563.8[医药卫生—治疗学]