严姝瑛,陈远卓,陈慧琳,李洺,徐华娟
YAN Shuying,CHEN Yuanzhuo,CHEN Huiling,LI Ming,XU Huajuan

• 1:上海建工医院重症医学科
• 2:同济大学附属第十人民医院重症医学科

摘要(Abstract)：

目的:探讨血清降钙素原清除率(PCT-c)及乳酸清除率(LCR)联合序贯性器官功能衰竭评分(SOFA)评分变化率(ΔSOFA)评估脓毒症预后的价值。方法:入住ICU的脓毒症患者121例,以住院的第28天为时间点分为存活组和死亡组,检测入ICU当天和治疗后24及48 h时的血清降钙素原(PCT)及乳酸(Lac)水平、计算PCT-c及LCR,并进行SOFA评分;建立受试者工作特征曲线(ROC曲线)、计算曲线下面积AUC值,比较单独或联合使用PCT-c、LCR和ΔSOFA对脓毒症患者预后的评估价值。结果:121例脓毒症患者中,存活82例(67. 77%),死亡39例(32. 23%),存活组24 h和48 h的PCT-c、LCR和ΔSOFA均明显高于死亡组(P <0. 05);单独指标48 h PCT-c的预测效能最强,AUC值为0. 936(95%CI为0. 872~0. 999),最佳临界值为-3. 48%,敏感度93. 9%,特异度87. 2%; 48 h PCT-c和LCR联合ΔSOFA的AUC值为0. 967(95%CI为0. 920~1. 000),在联合指标中预测价值最高。结论:PCT-c、LCR和ΔSOFA评分均可作为脓毒症患者预后评价指标,3项指标联合预测效能更强。
Objective: To investigate the value of clearance of procalcitonin(PCT-c) and lactate clearance rate(LCR) combined withΔsequential Organ Failure Assessment(SOFA) score in prognosis evaluation for patients with sepsis. Methods: 121 patients with sepsis admitted to ICU for 28 days were divided into survival group and death group. Their procalcitonin(PCT) and lactate levels(Lac)were detected on the day of ICU and 24 and 48 hours after treatment,and SOFA scores were evaluated. The receiver operating characteristic curve(ROC curve) was established and the area under the curve(AUC) were calculated. PCT-c,LCR and SOFA score used alone or in combination in patients with sepsis were compared to assess the value of prognosis. Result: In the 121 sepsis patients,82(67. 77%) survived and 39(32. 23%) died. The PCT-c,LCR andΔSOFA in the survival group were significantly higher than those in the death group at 24 h and 48 h(P < 0. 05). The prediction efficiency of 48 h PCT-c was the strongest in individual indicators,the AUC value was 0. 936(95% CI0. 872 ± 0. 999) when the cut-off value was-3. 48%,the sensitivity was 93. 9% and the specificity was 87. 2%; The AUC value of 48 h PCT-c and LCR Δcombined SOFA was 0. 967(95% CI 0. 920 ~1. 000),which was the highest in the combined index. Conclusion: The forecasting efficiency is stronger when the three indications are in combinatory use.

关键词(KeyWords)： 脓毒症;降钙素原;乳酸清除率;SOFA评分;预后
sepsis;procalcitonin;lactate clearance rate;sequential organ failure assessment;prognosis

Abstract:

Keywords:

基金项目(Foundation): 国家自然青年基金资助项目(81501696);; 上海市虹口区卫生局资助项目(1604-41)

作者(Author): 严姝瑛,陈远卓,陈慧琳,李洺,徐华娟
YAN Shuying,CHEN Yuanzhuo,CHEN Huiling,LI Ming,XU Huajuan

DOI: 10.19367/j.cnki.1000-2707.2018.11.013

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