粪便钙卫蛋白水平合并脓毒性休克对老年脓毒症患者预后有预测价值

贺琛哲.粪便钙卫蛋白水平合并脓毒性休克对老年脓毒症患者预后有预测价值[J].内科急危重症杂志,2025,31(6):559-563

DOI：10.11768/nkjwzzzz20250615

英文关键词:

基金项目:南京大学医学院附属鼓楼医院临床研究基金（2023-LCYJ-PY-30）；江苏省自然科学基金（SBK2021041897）

作者	单位	E-mail
贺琛哲	南京大学医学院附属鼓楼医院	yudrnj2@163.com

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中文摘要:

摘要目的：探讨粪便钙卫蛋白水平合并脓毒性休克对老年脓毒症患者预后的预测价值。方法：采用前瞻性研究收集老年脓毒症患者123例，记录并比较患者的一般临床资料、入院24 h内急性生理与慢性健康状况评估（APACHE II）评分、序贯器官衰竭（SOFA）评分和粪便钙卫蛋白水平。根据患者ICU的预后分为存活组86例和死亡组37例。采用Pearson相关系数法分析粪便钙卫蛋白与临床常用炎症指标的相关性，采用Logistic回归分析影响老年脓毒症患者预后的影响因素。采用受试者工作特征（ROC）曲线评价粪便钙卫蛋白对老年脓毒症患者预后的预测价值。结果：死亡组患者粪便钙卫蛋白、IL-6水平及合并脓毒性休克比例高于存活组（P均＜0.05）。粪便钙卫蛋白水平与IL-6呈正相关（r=0.366，P＜0.05）。多因素Logistic回归分析显示，粪便钙卫蛋白（OR=1.006，95%CI：1.004~1.009）、脓毒性休克（OR=12.475，95%CI：2.644~58.855）是老年脓毒症患者死亡的危险因素（P均＜0.05）。ROC曲线分析显示，粪便钙卫蛋白、脓毒性休克单独预测老年脓毒症患者死亡的曲线下面积（AUC）为0.918（95%CI：0.870~0.965）、0.681（95%CI：0.582~0.779），二者联合预测AUC最高为0.943(95%CI：0.902~0.985)。粪便钙卫蛋白的最佳截断值为672μg/g，灵敏度为0.860，特异性为0.892，约登指数为0.752。结论：粪便钙卫蛋白对老年脓毒症患者预后有较好的预测价值，与脓毒性休克联合预测，预测价值将会进一步提高。

英文摘要:

Abstract Objective: To explore the predictive value of fecal calprotectin level combined with septic shock in elderly patients with sepsis. Methods: The prospective study was conducted to collect 123 cases of elderly patients with sepsis. Their general clinical data, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score and fecal calprotectin levels within 24 h of admission were recorded and compared. The patients were divided into the death group of 37 cases and the survival group of 86 cases based on the patients' prognosis in ICU. Pearson correlation was used to analyze the correlation between fecal calprotectin and commonly used clinical inflammatory indicators. Logistic regression was used to analyze the risk factors for prognosis in elderly patients with sepsis. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of fecal calprotectin for prognosis in elderly patients with sepsis. Results: The level of fecal calprotectin, IL 6 and the proportion of patients complicated with septic shock in patients of the death group were higher than the survival group (all P< 0.05). The level of fecal calprotectin was positively correlated with IL 6 (r= 0.366, P< 0.05). Multivariable Logistic regression analysis showed that fecal calprotectin (OR= 1.006, 95%CI: 1.004-1.009), septic shock (OR= 12.475, 95%CI: 2.644-58.855) were risk factors for death in elderly patients with sepsis (all P< 0.05). ROC curve analysis demonstrated that the area under the curve (AUC) of fecal calprotectin and septic shock alone in predicting death in elderly patients with sepsis was 0.918 (95%CI: 0.870-0.965) and 0.681 (95%CI: 0.582-0.779) respectively, and their combination yielded the highest AUC of 0.943 (95%CI: 0.902-0.985). The optimal cutoff value of fecal calprotectin was 672μg/g with the Yoden index of 0.752, which yielded a sensitivity of 0.860 and a specificity of 0.892. Conclusions: Fecal calprotectin can be regarded as an effective predictor of prognosis in elderly patients with sepsis, and this predictive efficacy will be further improved in patients complicated with septic shock.