2024 年第 1 期 第 19 卷

重症脓毒症患者临床预后影响因素及相关指标对预后的预测效能分析

Analysis of influencing factors and predictive efficacy of related indicators on clinical prognosis in patients with severe sepsis

作者：林文佳 黄瑾瑜 甘日志 杨春兰

英文作者：Lin Wenjia Huang Jinyu Gan Rizhi Yang Chunlan

单位：广东医科大学附属医院急诊医学中心，湛江524023

英文单位：Emergency Medical Center Affiliated Hospital of Guangdong Medical University Zhanjiang 524023 China

关键词：脓毒症；预后；简化急性生理学评分Ⅱ；血小板计数

英文关键词：Sepsis;Prognosis;SimplifiedacutephysiologyscoreⅡ;Plateletcount

• 摘要：

• 目的  探讨重症脓毒症患者临床预后影响因素及相关指标对预后的预测效能，以期为预后不良高危人群筛选及临床治疗方案制定提供更多参考。方法  收集2018年1月至2022年12月于广东医科大学附属医院就诊的266例重症脓毒症患者的临床资料行回顾性分析。根据进入重症监护病房（ICU）后28 d是否死亡分为存活组（180例）和死亡组（86例）。比较存活组和死亡组基线临床特征资料，采用多因素Logistic回归方法评估重症脓毒症患者进入ICU后28 d死亡的影响因素；分析相关指标对重症脓毒症患者进入ICU后28 d死亡的预测效能。结果  死亡组序贯器官衰竭估计评分、简化急性生理学评分Ⅱ（SAPS Ⅱ）评分、降钙素原水平、C反应蛋白水平、进入ICU后24 h及48 h血小板计数下降值高于/大于存活组，差异均有统计学意义（均P<0.001）。多因素Logistic回归分析结果显示，SAPS Ⅱ评分、进入ICU后24 h及48 h血小板计数下降值均是重症脓毒症患者进入ICU后28 d死亡的独立危险因素（比值比=1.197、1.082、1.057，95%置信区间：1.125～1.275、1.053～1.112、1.034～1.080，均P<0.001）。受试者工作特征曲线分析结果显示SAPS Ⅱ评分、进入ICU后24 h及48 h血小板计数下降值、三者联合的约登指数分别为0.394、0.382、0.376、0.626，其中三者联合预测效果最优。结论  重症脓毒症患者进入ICU后28 d死亡与SAPS Ⅱ评分、进入ICU后24 h及48 h血小板计数下降值有关，以上指标联合用于重症脓毒症患者进入ICU后28 d死亡风险预测效能更优。

• Objective  To explore the influencing factors and predictive efficacy of related indicators on patients with severe sepsis, in order to provide more references for the screening of high-risk groups with poor prognosis and the formulation of clinical treatment plans. Methods  From January 2018 to December 2022, the clinical data of 266 patients with severe sepsis admitted to Affiliated Hospital of Guangdong Medical University were collected as retrospective analysis. They were divided into survival group(180 cases) and death group (86 cases) according to whether they died 28 d after entering the intensive care unit(ICU). The baseline clinical characteristics of the survival group and the death group were compared, the influencing factors of death of patients with severe sepsis 28 d after entering ICU were evaluated by multivariate Logistic regression method, and the predictive effect of relevant indicators on the death of patients with severe sepsis 28 d after entering ICU was analyzed. Results  Sequential organ failure assessment score, simplified acute physiology score Ⅱ(SAPS Ⅱ) score, procalcitonin level, C-reactive protein level, and the decrease of platelet count at 24 and 48 h after entering ICU in the death group were higher/greater than those in the survival group (all P<0.001). Multivariate Logistic regression analysis showed that SAPS Ⅱ score and the decrease of platelet count at 24 and 48 h after entering ICU were independent risk factors for death of patients with severe sepsis 28 d after entering ICU(odds ratio=1.197, 1.082, 1.057, 95% confidence interval: 1.125-1.275, 1.053-1.112, 1.034-1.080, all P<0.001). The analysis results of the receiver operating characteristic curve showed that SAPS Ⅱ score, the decrease of platelet count at 24 and 48 h after entering ICU, and the combined Youden index of the three were 0.394, 0.382, 0.376 and 0.626, respectively, and the combined prediction effect of the three was the best. Conclusion  The death of patients with severe sepsis 28 d after entering ICU is related to SAPS Ⅱ score and the decrease of platelet count at 24 and 48 h after entering ICU. The combination of above indicators is more effective in predicting the death risk of patients with severe sepsis 28 d after entering ICU.