老年脓毒症患者预后相关因素的价值探讨
The value of prognosis factors in elderly patients with sepsis

王旭涛,陈燕启.老年脓毒症患者预后相关因素的价值探讨[J].内科急危重症杂志,2017,23(1):

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英文关键词:mortality in emergency department sepsis artery lactate D-dimer sepsis prognosis

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作者	单位	E-mail
王旭涛	北京医院急诊科	wxt@medmail.com.cn
陈燕启	北京医院急诊科	yqpchen@126.com

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中文摘要:

【】目的：探讨预测老年脓毒症患者预后的相关因素的价值。方法：对2014年7月至2015年7月北京医院急诊抢救室和监护室的139例老年脓毒症患者,入院时检测C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体和动脉乳酸,并分别记录24小时的急诊脓毒症病死率 (MEDS) 评分、急性生理学与慢性健康情况评价系统Ⅱ(APACHE II)评分。根据28天的转归,将139例脓毒症患者分为存活组和死亡组,比较上述指标在两组间有无统计学差异。采用多因素logistic回归分析筛选其预测死亡的独立危险因素,应用受试者工作特征曲线(ROC曲线)比较危险因素的预测能力。结果：存活组80例,死亡组59例。两组比较,发现上述指标均有统计学意义。多因素logistic回归分析发现D-二聚体(OR=1.050,P=0.047)、动脉乳酸(OR=1.529,P=0.014)、MEDS评分(OR=1.180,P=0.012)和APACHE II评分(OR=1.103,P=0.036)是预测死亡的独立危险因素。D-二聚体、动脉乳酸、MEDS评分和APACHE II评分的ROC曲线下面积(AUC)分别为0.643、0.806、0.828、0.831。同APACHE II评分比较曲线下面积(AUC),动脉乳酸、MEDS评分的P值大于0.05,没有统计学意义。结论：MEDS评分、动脉乳酸、D-二聚体是预测老年脓毒症患者死亡的独立风险因素,MEDS评分、动脉乳酸预测能力与APACHE II评分相当。

英文摘要:

【】Object: To investigate the value of factor on predicting the prognosis of elderly patients with sepsis. Methods:139 elderly patients in the emergency rescue room and intensive care unit(ICU)of Beijing hospital from July 2014 to July 2015,were determined C-reactive protein(CRP)、procalcitonin(PCT)、D-Dimer and artery lactate(LAC) at admission, mortality in emergency department sepsis(MEDS)score and acute physiology and chronic health evaluationⅡ(APACHE Ⅱ)score were estimated within 24 hours. According to the 28 days of survival outcome, 139 patients were divided into two groups: survival group and death group to compare the above indeses . Multivariate logistic regression analysis was used to screen independent risk factors for the prediction of death. The receiver operating characteristic curve (ROC curve) was compared the predictive ability of the risk factors. Results: 80 patients in the survival group, 59 cases in the death group. Comparing the two groups, found the above indexes have all statistical significance. Multivariate logistic regression analysis found that D- dimer(OR=1.050,P=0.047)、artery lactate(OR=1.529,P=0.014)、MEDS(OR=1.180,P=0.012) score and APACHE II score(OR=1.103,P=0.036) were independent risk factors of predicting death. The area under curve(AUC) of ROC about D- dimer、artery lactate、MEDS score and APACHE II score were respective0.643、0.806、0.828 and 0.831. With the APACHE II score AUC comparison, arterial lactate、MEDS score P values were mroe than 0.05, no statistical significance.Conclusion:MEDS score、arterial lactate、D-dimerwere independent risk factor for predicting death of elderly patients with sepsis.MEDS score、arterial lactate prediction ability were equivalent to APACHE II score.