快速序贯器官功能衰竭评分联合红细胞分布宽度对老年脓毒症患者预后的预测价值

Predictive value of quick sequential organ failure assessment combined with rde blood cell distribution width for prognosis of elderly septic patients

摘要:

目的 研究快速序贯器官功能衰竭评分(qSOFA)联合红细胞分布宽度(RDW)对老年脓毒症患者预后的预测价值。 方法 选取2016年6月至2019年6月在河北北方学院附属第一医院急诊科收治的老年脓毒症患者124例进行回顾性研究。根据30d的预后情况分为存活组(78例)和死亡组(46例)。主要收集患者实验室检验数据、急性生理慢性健康评分(APACHE Ⅱ)和qSOFA评分。采用t检验、秩和检验及χ²检验比较组间差异；采用Cox回归模型分析预后影响因素；采用Kaplan-Meier曲线分析不同qSOFA、RDW患者预后的差异；采用ROC曲线分析qSOFA、RDW对老年脓毒症患者预后的预测价值。 结果 与存活组相比,死亡组患者的RDW、肌酐、降钙素原、APACHE Ⅱ评分、qSOFA评分明显增加(P<0.05)；Cox回归分析显示,RDW、APACHE Ⅱ、qSOFA是脓毒症患者预后的影响因素(P<0.05)；Kaplan-Meier曲线分析显示,不同qSOFA、RDW患者的预后情况差异有统计学意义(P<0.05)；在logistic回归模型中生成qSOFA联合RDW预测老年脓毒症患者预后的新指标(-5.728+0.505×qSOFA+0.339×RDW),并进行ROC曲线分析,结果显示合成指标对老年脓毒症患者的预后具有预测价值,最佳截断点为-0.6144,其灵敏度和特异度分别为60.87%和79.49%,优于单一指标。结论 qSOFA和RDW是老年脓毒症患者预后的影响因素,qSOFA联合RDW用于预测老年脓毒症患者预后具有更高的灵敏度和特异度。

Abstract:

Objective To explore the predictive value of quick sequential organ failure assessment (qSOFA) combined with red blood cell distribution width (RDW) for prognosis in the elderly patients with sepsis. Methods Totally 124 the elderly septic patients (≥60 years) with laboratory data, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and quick sequential organ failure assessment (qSOFA) admitted in First Affiliated Hospital of Hebei North University from June 2016 to June 2019 were enrolled in this retrospective study. According to the prognosis in 30 d after hospitalization, they were divided into the survival group (78) and the death group (46). The differences of clinical data between the two groups were compared by student′s t test, non-parametric test and Chi-square test. The influencing factors of prognosis were analyzed by Cox regression model. Kaplan-Meier curve was used to analyze the differences of prognosis among the patients with different qSOFA and RDW. The predictive value of qSOFA and RDW on prognosis were analyzed by receiver operating characteristic (ROC) curve. Results Compared with the survival group, the dead group had significantly wider RDW, higher levels of creatinine and procalcitonin, and higher points of APACHE Ⅱ and qSOFA (P<0.05). Cox regression model showed RDW, APACHE Ⅱ and qSOF were prognostic factors for sepsis (P<0.05). Kaplan Meier curve analysis indicated that the prognosis of patients with different qSOFA and RDW differed from each other statistically (P<0.05). Logistic regression model displayed that combined qSOFA and RDW was a new index in the prognosis prediction of the elderly septic patients (-5.728+0.505×qSOFA+0.339×RDW), and ROC curve analysis indicated that the best cutoff value of this index was -0.6144, with the sensitivity and specificity of 60.87% and 79.49%, respectively, which were better than single index. Conclusion qSOFA and RDW are the influencing factors of the prognosis of the elderly septic patients, and qSOFA combined with RDW has better sensitivity and specificity in prognostic evaluation of the elderly septic patients.