重症病毒性肺炎患者28天死亡风险因素分析

吴钟辉.重症病毒性肺炎患者28天死亡风险因素分析[J].内科急危重症杂志,2022,28(4):277-280

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DOI：10.11768/nkjwzzzz20220404

中文关键词: 重症病毒性肺炎血清淀粉样蛋白A 中性粒细胞/淋巴细胞比值预后

英文关键词:

基金项目:广东省科学技术厅2017年省自筹经费类科技计划项目（No：2017ZC0089）

作者	单位	E-mail
吴钟辉	海口市第四人民医院重症医学科	hexinhuxyl@126.com

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中文摘要:

目的：分析重症病毒性肺炎患者28 d死亡风险因素。方法：回顾性分析57例重症病毒性肺炎患者的临床病历资料，根据患者28 d内是否死亡分为存活组38例和死亡组19例。采用多因素Logistic回归分析确定重症病毒性肺炎患者死亡风险因素，并利用受试者工作特征曲线（ROC）评估各指标对患者28 d死亡风险的预测价值。结果：与死亡组比较，存活组患者的年龄偏小、机械通气时间长、中性粒细胞/淋巴细胞比值（NLR）及血清淀粉样蛋白A（SAA）水平较低；氧合指数（PaO2/FiO2）、淋巴细胞计数（LYM）较高（P均<0.05）。二元Logistic回归方程分析显示入院时年龄、机械通气时间、NLR、SAA是重症病毒性肺炎患者28d死亡的独立危险因素（P均<0.05）。NLR预测重症病毒性肺炎患者28 d死亡风险的ROC曲线下面积为0.790，最佳截断值为11.12，敏感度81.62%，特异性63.24%。SAA预测重症病毒性肺炎患者28 d死亡风险的ROC曲线下面积为0.707，最佳截断值为171.00，敏感度73.77%，特异性58.10%。结论：年龄大、机械通气时间短、高水平的NLR和SAA是重症病毒性肺炎患者死亡的高危因素，其中高水平NLR对患者28 d死亡风险具有良好的预测价值。

英文摘要:

Objective: To analyze the risk factors of 28-d mortality in patients with severe viral pneumonia. Methods: The clinical data of 57 patients with severe viral pneumonia were retrospectively analyzed. According to whether the patients died within 28 days, they were divided into survival group (38 cases) and death group (19 cases). Multivariate Logistic regression analysis was used to determine the risk factors for death in patients with severe viral pneumonia, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each index on the risk of death in patients with severe viral pneumonia within 28 days. Results: Compared with the death group, the survival group had younger age, shorter duration of mechanical ventilation, lower neutrophil lymphocyte ratio (NLR) and lower serum amyloid A(SAA) level. The oxygenation index (PaO2/FiO2) and lymphocyte count (LYM) were higher (P< 0.05). Binary Logistic regression analysis showed that age at admission, duration of mechanical ventilation, NLR and SAA were independent risk factors for 28d death in patients with severe viral pneumonia (P< 0.05). The area under ROC curve (AUC) of NLR for predicting 28d mortality risk in patients with severe viral pneumonia was 0.790, the best cut-off value was 11.12, the sensitivity was 81.62%, and the specificity was 63.24%. The AUC of SAA for predicting the 28-d mortality risk of patients with severe viral pneumonia was 0.707, the best cut-off value was 171.00, the sensitivity was 73.77%, and the specificity was 58.10%. Conclusion: Older age, shorter duration of mechanical ventilation and high level of NLR and SAA are high risk factors for death in patients with severe viral pneumonia, and high level of NLR has a good predictive value for 28-d death risk.