摘要
目的探讨重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)的风险因素,并建立SAP合并ARDS的多指标早期联合预测模型。方法回顾性分析2015年1月至2020年12月山东省日照市中医医院重症医学科、急诊科收治的168例SAP患者的临床资料。根据发病后24 h是否发生ARDS将患者分为ARDS组与非ARDS组,对比两组患者入院后24 h内的临床检验指标;采用单因素分析、有序多分类Logistic回归分析筛选出SAP发生ARDS的独立因素,联合各独立预测指标构建ARDS非加权预测模型(unwScore)和加权预测模型(wScore)。采用受试者工作特征曲线(ROC)确定各指标、预测模型的最佳截断值,并分析各独立预测指标及预测模型的临床预测效果。结果共纳入168例SAP患者,男性90例,女性78例;平均年龄(59.37±15.27)岁;ARDS组69例,非ARDS组99例。单因素及有序多分类Logistic回归分析结果显示,动脉血氧分压(PaO_(2))、血乳酸(Lac)、降钙素原(PCT)和膀胱压是SAP患者发生ADRS的独立影响因素。利用ROC曲线计算上述指标预测ARDS的截断值,并建立unwScore模型,截断值为1.5时,随着模型分值的增高,ARDS的发生概率增高,ROC曲线下面积(AUC)为0.951,敏感度为94.2%,特异度为79.8%,阳性预测值为76.5%,阴性预测值为87.2%。对PaO_(2)、Lac、PCT和膀胱压进行二分类Logistic回归分析,建立wScore模型,该模型预测SAP患者发生ARDS的AUC为0.987,敏感度为99.6%,特异度为83.1%,阳性预测值98.9%,阴性预测值为95.3%,均优于各独立指标及unwScore模型。结论PaO_(2)、Lac、PCT和膀胱压为SAP发生ARDS的独立影响因素;SAP发生ARDS的多指标联合预测模型具有良好的临床预测效果,可为SAP发生ARDS的早期预测及治疗提供临床参考。
Objective To explore the risk factors of severe acute pancreatitis(SAP)complicated with acute respiratory distress syndrome(ARDS),and to establish a multi-index early combined prediction model of SAP complicated with ARDS.Methods The clinical data of 168 patients with SAP from January 2015 to December 2020 were retrospectively analyzed.The patients were divided into ARDS group and non-ARDS group according to the occurrence of ARDS within 24 hours after onset.Univariate analysis and ordinal Logistic regression analysis were used to screen out the independent factors of ARDS in SAP.The unweighted prediction model(unwScore)and weighted prediction model(wScore)of ARDS were constructed by combining the independent prediction indexes.Receiver operator characteristic curve(ROC)was used to determine the best cut-off value of each index and prediction model,and the clinical prediction effect of each independent prediction index and prediction model was analyzed.Results A total of 168 SAP patients(90 males and 78 females)were enrolled;average age(59.37±15.27)years old;69 cases in ARDS group and 99 cases in non-ARDS group.Univariate and ordered multiple Logistic regression analysis showed that the arterial partial pressure of oxygen(PaO2),blood lactic acid(Lac),procalcitonin(PCT)and bladder pressure were the independent influencing factors of ADRS in SAP patients.The cut-off value of the above indicators was calculated by ROC curve,and the unwScore model was established.The cut-off value was 1.5,with the increase of the model score,the probability of ARDS increased.The area under the ROC curve(AUC)was 0.951,the sensitivity was 94.2%,the specificity was 79.8%,the positive predictive value was 76.5%,and the negative predictive value was 87.2%.The AUC,sensitivity,specificity,positive predictive value and negative predictive value of wScore model for predicting ARDS in SAP patients were 0.987,99.6%,83.1%,98.9%and 95.3%,which were better than the independent indicators and the unwScore model.Conclusions PaO_(2),Lac,PCT and blad
作者
卢洪军
厉兵
崔乃强
张大鹏
Lu Hongjun;Li Bing;Cui Naiqiang;Zhang Dapeng(Department of Critical Care Medicine,Traditional Chinese Medicine Hospital of Rizhao,Rizhao 276800,Shandong,China;Department of Hepatobiliary and Pancreatic Surgery,Tianjin Nankai Hospital,Tianjin,300100)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2021年第6期658-661,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
山东省中医药科技发展规划项目(2019-0809)。
关键词
重症急性胰腺炎
急性呼吸窘迫综合征
风险分析
模型预测
Severe acute pancreatitis
Acute respiratory distress syndrome
Risk analysis
Model prediction
