基于ATⅢ、PC、SOFA评分联合、APACHEⅡ评分构建脓毒症预后模型  

Construction of sepsis prognosis model based on antithrombinⅢ,plasma protein C,SOFA score combined with acute physiology and chronic health evaluationⅡscore

作　　者：陈园园 鲁杏 方长太[1] 李晓倩 查佳安 CHEN Yuanyuan;LU Xin;FANG Changtai;LI Xiaoqian;ZHA Jiaan(Department of Critical Care Medicine,Anqing Municipal Hospital,Anqing 246000,Anhui,China;Department of Emergency,Anqing Municipal Hospital,Anqing 246000,Anhui,China)

机构地区：[1]安庆市立医院重症医学科,安徽安庆246000 [2]安庆市立医院急诊科,安徽安庆246000

出　　处：《中南医学科学杂志》2025年第1期145-148,共4页Medical Science Journal of Central South China

基　　金：安庆市科学技术局科研技术项目(2021Z2015);皖南医学院临床医学科研基金项目(WK2023JXYY026)。

摘　　要：目的基于血浆抗凝血酶Ⅲ(ATⅢ)、血浆蛋白C(PC)、序贯器官衰竭评估量表(SOFA)、急性生理功能和慢性健康状态(APACHEⅡ)评分水平,探讨脓毒症患者预后的影响因素,构建列线图预测模型并评价其效能。方法回顾性分析241例脓毒症患者,根据患者入ICU后28天内预后情况将其分为存活组(142例)和死亡组(99例)。回顾性收集患者入ICU当天的血小板计数(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、胆红素(TBIL)、谷丙转氨酶(GPT)、谷草转氨酶(GOT)、ATⅢ活性、PC活性以及患者入ICU当天的APACHEⅡ评分和SOFA评分等指标。采用多因素Logistic回归分析评估脓毒症患者预后的影响因素,并构建列线图预测模型,采用ROC曲线、校准图和决策曲线分析(DCA)评价预测模型的效能。结果死亡组血浆PT、APTT、D-D、TBIL、GPT、PLT、ATⅢ、PC水平与存活组比较,差异均有统计学意义(P<0.05)。成功构建预测模型,该模型AUC为0.813,拟合性较好(P=0.08),净受益高。结论基于ATⅢ、PC、SOFA评分联合APACHEⅡ评分构建的模型可用于早期预测脓毒症患者的预后。Aim To explore the influencing factors of prognosis in patients with sepsis based on plasma antithrombinⅢ(ATⅢ),plasma protein C(PC),sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation(APACHEⅡ)scores,as well as to construct a nomogram prediction model and evaluate its efficacy.Methods 241 sepsis patients were divided into survival group(n=142)and death group(n=99)according to the prognosis within 28 days after admission to ICU.The platelet count(PLT),plasma prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-dimer(D-D),bilirubin(TBIL),glutamic-pyruvic transaminase(GPT),glutamic-oxaloacetic transaminase(GOT),ATⅢactivity and PC activity on the day of ICU admission were retrospectively collected,and APACHEⅡscore and SOFA score on the day of ICU admission were also recorded.Multivariate logistic regression analysis was used to evaluate the influencing factors of the prognosis of patients with sepsis,and a nomogram prediction model was constructed.ROC curve,calibration chart and decision curve analysis(DCA)were used to evaluate the efficacy of the prediction model.Results The plasma levels of PT,APTT,D-D,TBIL,GPT,PLT,ATⅢand PC in the death group were significantly different from those in the survival group(P<0.05).The prediction model was successfully constructed,and the AUC of the model was 0.813,with good fitting(P=0.08)and high net benefit.Conclusion The model based on ATⅢ,PC,SOFA score combined with APACHEⅡscore can be used to predict the prognosis of patients with sepsis.

关 键 词：脓毒症 预后 模型 抗凝血酶Ⅲ 血浆蛋白C 

分 类 号：R515[医药卫生—内科学]