摘要
目的回顾性分析凝血指标联合简化急性生理评分对脓毒性休克患者的预后预测作用。方法采用秩和检验比较院内存活及死亡两组患者的实验室指标进行ROC曲线分析,并采用单因素Logistic回归筛选患者院内死亡的危险因素,继而用多因素Logistic向前拟合的方法构建联合预测模型,利用ROC及曲线下面积评价联合凝血指标后的凝血-简化急性生理评分诊断效能及对于患者预后的预测作用。结果本研究共纳入1010例患者,院内死亡患者337例,存活患者673例。秩和检验提示院内死亡组及存活组间存在统计学差异的指标有SOFA评分、SAPSⅡ评分、血小板、APTT值、PT值、INR。ROC曲线得出截断值并进行赋值后,单因素Logistic回归分析结果显示SAPSⅡ评分>49分、国际标准化比值>1.8、活化部分凝血活酶时间>41.4、凝血酶原时间>18.3、血小板<139为患者院内死亡的独立危险因素。多因素Logistic回归向前构建回归模型后凝血-SAPSⅡ评分的诊断效能(AUC=0.744)高于简化急性生理评分(AUC=0.699)及单独的凝血指标,两者面积差异P<0.05,差异具有统计学意义。结论联合APTT、INR、血小板后的SAPSⅡ评分能更好地预测脓毒性休克患者的院内死亡风险。
Objective Retrospective analyze the prognostic value of coagulation index combined with simplified acute physiological score in patients with septic shock.Methods The data of this study were extracted from the database of single center intensive care medical information center.The outcome of this study was in-hospital death.The rank sum test was used to compare the laboratory data of the two groups of patients living and dead in the hospital,and then the ROC curve analysis of each index was carried out.After the cut-off value was obtained and assigned,the risk factors of inhospital death were screened by univariate logistic regression,and then the joint prediction model was constructed by multivariate logistic forward fitting method,ROC and area under the curve were used to evaluate the diagnostic efficacy of coagulation simplified acute physiological score after combined coagulation indexes and its predictive effect on the prognosis of patients.Results A total of 1010 patients were included in this study,337 patients died and 673 patients survived.Rank sum test showed that there were significant differences between in-hospital death group and in-hospital living group,including SOFA score,SAPSⅡscore,platelet,APTT value,Pt value and INR.After the cut-off value of ROC curve was obtained and assigned,the results of univariate logistic regression analysis showed that SAPSⅡscore greater than49,international standardized ratio greater than1.8,activated partial thromboplastin time greater than 41.4 and platelet less than 139 were the independent risk factors of in-hospital death.The diagnostic efficacy of coagulation sapsⅡscore(AUC=0.744)was higher than that of Simplified Acute Physiology Score(AUC=0.699),and the area difference test was P<0.05.Conclusions The combination of APTT,INR and sapsⅡscore after platelets within 24 hours after admission can better predict the in-hospital death of patients with septic shock.
作者
江威铭
姜豪
潘景业
Jiang Weiming;Jiang Hao;Pan Jingye(Department of critical medicine,the First Affiliated Hospital of Wenzhou Medical University,Key Laboratory of Critical Emergency and Artificial Intelligence of Zhejiang Province,Wenzhou,China)
基金
国家自然科学基金(项目编号:81873949)
关键词
脓毒性休克
简化急性生理评分
凝血功能
预后预测
Septic shock
Simplified acute physiology score
Coagulation function
Prognosis prediction
