急诊脓毒症患者前蛋白转化酶枯草溶菌素9、降钙素原/白蛋白和乳酸与近期预后的相关性  

Correlation of proprotein convertase subtilisin/kexin type 9,procalcitonin/albumin and lactate levels with short-term prognosis in sepsis patients

作　　者：蒋伟强 杜力文 Jiang Weiqiang;Du Liwen(Health Science Department of Ningbo University,Ningbo 315211,China)

机构地区：[1]宁波大学医学部,浙江宁波315211 [2]上海交通大学医学院附属仁济医院宁波医院(宁波市杭州湾医院)急诊科,浙江宁波315336 [3]宁波市第二医院急诊科,浙江宁波315000

出　　处：《中国急救医学》2025年第4期323-328,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨急诊脓毒症患者前蛋白转化酶枯草溶菌素9(PSCK9)、降钙素原/白蛋白(PCT/ALB)、乳酸水平与近期预后的相关性。方法 以2021年8月至2024年11月就诊于我院急诊重症监护室的268例脓毒症患者作为研究对象,根据入院后30天内存活情况分为近期预后良好组(n=193)和近期预后不良组(n=75)。对比两组患者一般临床资料、病情主观评分、PSCK9、PCT/ALB、乳酸等指标的差异。通过单因素及多因素Logistic回归分析评价各指标与急诊脓毒症患者近期预后的相关性,并通过受试者工作特征(ROC)曲线、曲线下面积(AUC)评价各因素独立或联合预测的效能及差异。通过决策曲线、校准曲线评价该模型用于预测脓毒症患者近期预后不良的有效性和准确性。结果 近期预后不良组患者APACHEⅡ评分、SOFA评分、年龄、血清PSCK9、PCT/ALB、乳酸均高于预后良好组(P<0.05);单因素及多因素Logistic回归分析显示,APACHEⅡ评分、SOFA评分、血清PSCK9、PCT/ALB、乳酸是急诊脓毒症患者近期预后不良的独立危险因素(P<0.05);ROC曲线分析显示,APACHEⅡ评分、SOFA评分、PSCK9、PCT/ALB、乳酸联合预测急诊脓毒症患者近期预后不良的AUC(95%CI)为0.719(0.647~0.791)(P<0.05);校准曲线分析显示,基于APACHEⅡ评分、SOFA评分、PSCK9、PCT/ALB、乳酸的预测模型校准度较好(Hosmer-Lemeshowχ^(2)=11.956,P=0.153);决策曲线分析显示,当高风险阈值在0~0.80区间时模型预测的净收益率均>0。结论 急诊脓毒症患者APACHEⅡ评分、SOFA评分、血清PSCK9、PCT/ALB、乳酸均与近期预后不良存在密切相关性,且上述指标联合用于辅助预测急诊脓毒症患者近期预后的效能更高。Objective To explore the correlation of proprotein convertase subtilisin/kexin type 9(PSCK9),procalcitonin/albumin(PCT/ALB)and lactate levels with short-term prognosis in sepsis patients.Methods A total of 268 emergency sepsis patients admitted to the emergency intensive care unit of our hospital from August 2021 to November 2024 were selected as the research subjects.According to their survival status within 30 days after admission,they were divided into the good short-term prognosis group(n=193)and the poor short-term prognosis group(n=75).The general clinical data,subjective disease severity scores,PSCK9,PCT/ALB,lactate and other indicators of the two groups were compared in terms of characteristics and differences.Univariate and multivariate Logistic regression analyses were used to evaluate the correlation between each indicator and the short-term prognosis of emergency sepsis patients.The efficacy and differences of independent or combined prediction of the relevant indexes were evaluated by the receiver operating characteristic(ROC)curve and the area under curve(AUC)test.The effectiveness and accuracy of the model for predicting poor short-term prognosis in sepsis patients were evaluated by the decision curve and calibration curve.Results The acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,age,serum PSCK9,PCT/ALB and lactate in the poor short-term prognosis group were higher than those in the good short-term prognosis group(P<0.05).Univariate and multivariate Logistic regression analyses showed that the APACHEⅡscore,SOFA score,serum PSCK9,PCT/ALB and lactate were independent risk factors for poor short-term prognosis in emergency sepsis patients(P<0.05).ROC curve analysis showed that the AUC(95%CI)of the combined prediction for poor short-term prognosis in emergency sepsis patients by APACHEⅡscore,SOFA score,PSCK9,PCT/ALB and lactate was 0.719(0.647-0.791)(P<0.05).Calibration curve analysis indicated that the prediction model based on the

关 键 词：脓毒症 前蛋白转化酶枯草溶菌素9 降钙素原/白蛋白 乳酸 预后 

分 类 号：R47[医药卫生—护理学]