老年脓毒症临床特点及死亡风险评估量表的建立和评价  

Clinical characteristics of elderly patients with sepsis and development and evaluation of death risk assessment scale

作　　者：董服波 罗黎文 洪德江 姚奕 彭凯 李文锦 赵光举[1] Dong Fubo;Luo Liwen;Hong Dejiang;Yao Yi;Peng Kai;Li Wenjin;Zhao Guangju(Department of Emergency,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院急诊科,浙江温州325000

出　　处：《中华危重病急救医学》2025年第1期17-22,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金(82272202)。

摘　　要：目的分析老年脓毒症患者的临床特征,识别影响其临床结局的关键因素,构建一套老年脓毒症患者死亡风险评估量表并评估其预测价值。方法采用回顾性病例对照研究方法,收集2021年9月至2023年9月温州医科大学附属第一医院重症监护病房(ICU)收治的脓毒症患者的临床资料,包括患者的基本信息、临床特征及临床结局。根据年龄将患者分为非老年组(年龄<65岁)与老年组(年龄≥65岁),根据30 d生存状况进一步将老年组患者分为生存组与死亡组。分析老年脓毒症患者的临床特征。采用单因素和多因素Logistic回归分析筛选老年脓毒症患者30 d死亡的独立危险因素,并构建回归方程;通过简化回归方程建立死亡风险评估量表;比较不同评分对老年脓毒症患者预后的预测价值。结果①最终共纳入833例脓毒症患者,其中老年组485例,非老年组348例。与非老年组比较,老年组患者淋巴细胞、T细胞、CD8^(+)T细胞数量及T细胞和CD8^(+)T细胞比例更低〔淋巴细胞计数(×10^(9)/L):0.71(0.43,1.06)比0.83(0.53,1.26),T细胞数(个/μL):394.0(216.0,648.0)比490.5(270.5,793.0),CD8^(+)T细胞数(个/μL):126.0(62.0,223.5)比180.0(101.0,312.0),T细胞比例:0.60(0.48,0.70)比0.64(0.51,0.75),CD8^(+)T细胞比例:0.19(0.13,0.28)比0.24(0.16,0.34),均P<0.01〕,自然杀伤细胞(NK细胞)数量、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、住院期间接受有创机械通气(IMV)比例、30 d病死率更高〔NK细胞数(个/μL):112.0(61.0,187.5)比95.0(53.0,151.0),APACHEⅡ评分(分):16.00(12.00,21.00)比13.00(8.00,17.00),IMV比例:40.6%(197/485)比31.9%(111/348),30 d病死率:28.9%(140/485)比19.5%(68/348),均P<0.05〕,ICU住院时间更长〔d:5.5(3.0,10.0)比5.0(3.0,8.0),P<0.05〕;两组C-反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、γ-干扰素(IFN-γ)、白细胞介素(IL-2、IL-4、IL-6、IL-10)等炎症指标差异均无统计学意义。②485例老年脓�Objective To analyze the clinical characteristics of elderly patients with sepsis,identify the key factors affecting their clinical outcomes,construct a death risk assessment scale for elderly patients with sepsis,and evaluate its predictive value.MethodsA retrospective case-control study was conducted.The clinical data of sepsis patients admitted to intensive care unit(ICU)of the First Affiliated Hospital of Wenzhou Medical University from September 2021 to September 2023 were collected,including basic information,clinical characteristics,and clinical outcomes.The patients were divided into non-elderly group(age≥65 years old)and elderly group(age<65 years old)based on age.Additionally,the elderly patients were divided into survival group and death group based on their 30-day survival status.The clinical characteristics of elderly patients with sepsis were analyzed.Univariate and multivariate Logistic regression analyses were used to screen the independent risk factors for 30-day death in elderly patients with sepsis,and the regression equation was constructed.The regression equation was simplified,and the death risk assessment scale was established.The predictive value of different scores for the prognosis of elderly patients with sepsis was compared.Results①A total of 833 patients with sepsis were finally enrolled,including 485 in the elderly group and 348 in the non-elderly group.Compared with the non-elderly group,the elderly group showed significantly lower counts of lymphocyte,T cell,CD8^(+)T cell,and the ratio of T cells and CD8^(+)T cells[lymphocyte count(×10^(9)/L):0.71(0.43,1.06)vs.0.83(0.53,1.26),T cell count(cells/μL):394.0(216.0,648.0)vs.490.5(270.5,793.0),CD8^(+)T cell count(cells/μL):126.0(62.0,223.5)vs.180.0(101.0,312.0),T cell ratio:0.60(0.48,0.70)vs.0.64(0.51,0.75),CD8^(+)T cell ratio:0.19(0.13,0.28)vs.0.24(0.16,0.34),all P<0.01],higher natural killer cell(NK cell)count,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,ratio of invasive mechanical ventilation(IMV)during ho

关 键 词：脓毒症 老年 死亡风险 评估量表 预后 

分 类 号：R459.7[医药卫生—急诊医学]