摘要
目的研究辅助前急性生理和慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)联合早期全血细胞亚型比值(systematic inflammation markers,SIMs)在静脉-动脉体外膜肺氧合(venous-arterial extracorporeal membrane oxygenation,VA-ECMO)成人患者中的应用并探讨其对预后的影响。方法回顾性分析2017年1月至2020年6月于江苏省人民医院急诊科行VA-ECMO治疗(时间≥3 d)的成人患者共89例。分析死亡组(n=50)和存活组(n=39)患者的基线资料差异、辅助前APACHEⅡ评分以及血小板/淋巴细胞比值(platelet-tolymphocyte ratio,PLR)、中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、单核细胞/淋巴细胞比值(lymphocyte-to-monocyte ratio,LMR)在ECMO辅助前后各个时间点的分布情况,采用二元logistic回归分析VA-ECMO患者28 d死亡的相关危险因素,使用预测模型建立ROC曲线,根据最佳截断值分组,比较高风险组和低风险组ECMO相关并发症的差异。结果PLR 48 h、LMR 24 h、LMR 72 h、辅助前APACHEⅡ评分为VA-ECMO患者28 d死亡的相关危险因素。比较APACHEⅡ及PLR、LMR不同组合对VA-ECMO患者生存预后的诊断价值,结果显示APACHEⅡ+PLR 48 h+LMR 24 h+LMR 72 h联合诊断时ROC曲线下面积最大为0.833。低风险组相较于高风险组具有较低的急性肾损伤、感染、出血发生率,连续性肾脏替代治疗、机械通气治疗使用率以及较高的出院存活率。结论在成人VA-ECMO支持过程中辅助前APACHEⅡ评分联合早期全血细胞亚型比值PLR、LMR对于ECMO患者的预后风险评估具有较好的预测价值,有望成为一种新的预测模型用来早期识别VA-ECMO患者的死亡风险或不良预后。
Objective To investigate the clinical significance of the acute physiology and chronic health evaluationⅡ(APACHEⅡ)combined with different systematic inflammation markers(SIMs)including neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and lymphocyte-tomonocyte ratio(LMR)-in adult patients with venous-arterial extracorporeal membrane oxygenation(VAECMO).Methods A total of 89 adult patients with VA-ECMO(≥3 d)in the Emergency Department of Jiangsu Provincial People's Hospital from January 2017 to June 2020 were retrospectively analyzed.Patients were divided into two groups:survivors(n=39)and non-survivors(n=50).The baseline APACHEⅡscore and PLR,NLR,LMR before ECMO implantation and at 1,2,3 day after ECMO were recorded.Binary logistic regression was used to analyze the risk factors of 28-day mortality in patients with VAECMO.The utility of APACHEⅡscore and SIMs alone or combination for predicting clinical prognosis was evaluated using receiver operating characteristic(ROC)curve analysis.The patients were divided into the high risk group and the low risk group according to the best cut-off value,and the difference of ECMOrelated complications between the two groups was compared.Results When combined APACHEⅡscore with SIMs,APACHEⅡ+PLR 48 h+LMR 24 h+LMR 72 h demonstrated the greatest predictive ability with an AUC of 0.833.Compared with the high-risk group,the low-risk group has a lower incidence of acute renal injury,infection,bleeding complications,the use of continuous renal replacement therapy,mechanical ventilation,and a higher hospital survival rate.Conclusions The combination of APACHEⅡscore and SIMs-PLR,LMR-is better than a single one for death prediction,and it is expected to be a new predictive model for early identification of the risk of death or poor prognosis in patients with VA-ECMO.
作者
安迪
陈旭锋
李伟
朱轶
张忠满
邹乐
丁涛
徐微笑
An Di;Chen Xufeng;Li Wei;Zhu Yi;Zhang Zhongman;Zou Yue;Ding Tao;Xu Weixiao(Department of Emergency Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2022年第11期1498-1503,共6页
Chinese Journal of Emergency Medicine
基金
江苏省“六大人才高峰”(2019WSN-005)
江苏省“六个一工程”拔尖人才(LGY20190688)
江苏省人民医院“511腾飞工程”(2018)。
关键词
急性生理和慢性健康评分Ⅱ
血小板/淋巴细胞比值
单核细胞/淋巴细胞比值
炎症
体外膜肺氧合
预后
联合预测
Acute physiology and chronic health scoreⅡ
Platelet-to-lymphocyte ratio
Lymphocyte-to-monocyte ratio
Inflammation
Extracorporeal membrane oxygenation
Prognosis
Combined prediction
