摘要
目的探讨静脉-动脉体外膜肺氧合后生存(survival after veno-arterial ECMO,SAVE)评分联合上机24 h乳酸对体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者预后的预测价值。方法回顾分析2017年4月至2021年6月间于南京医科大学第一附属医院急诊科行ECPR治疗的患者共59例。根据28 d生存情况将患者分为死亡组(n=36)和存活组(n=23)。分析基线资料差异,并通过多因素Logistic回归分析确定ECPR患者28 d死亡的相关危险因素。利用受试者工作特征(ROC)曲线评估SAVE评分、上机24 h乳酸及两者联合检测对ECPR患者28 d死亡风险的预测价值。结果ECPR患者28 d生存率为39%(23/59)。死亡组SAVE评分明显低于存活组[(-11.67±4.60)vs.(-2.43±4.77),P<0.001],上机24 h乳酸明显高于存活组[5.94(3.37,12.40)mmol/L vs.1.65(1.07,3.15)mmol/L,P<0.001]。多因素Logistic回归分析显示,SAVE评分(OR=0.703,95%CI:0.566~0.873,P=0.001)和上机24 h乳酸(OR=1.608,95%CI:1.025~2.523,P=0.039)为ECPR患者28 d病死率的独立影响因素。ROC曲线分析结果显示:SAVE评分最佳截断值为-6分,诊断敏感度为78.30%,特异度为91.70%;上机24 h乳酸最佳截断值为4.7 mmol/L,诊断敏感度为63.90%,特异度为100.00%;两者联合检测的诊断敏感度为82.60%,特异度为100.00%。SAVE评分与上机24 h乳酸联合检测预测ECPR患者28 d死亡风险的曲线下面积高于两个指标单独预测(0.952 vs.0.917;0.952 vs.0.847)。结论SAVE评分降低、上机24 h血乳酸升高是ECPR患者28 d死亡的危险因素,两者联合检测对ECPR患者的预后具有良好的预测价值。
Objective To explore the prognostic value of survival after veno-arterial ECMO(SAVE)score combined with 24-h lactate on the machine in patients with extracorporeal cardiopulmonary resuscitation(ECPR).Methods Totally 59 patients treated with ECPR in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from April 2017 to June 2021 were retrospectively analyzed.According to the 28-day prognosis,the patients were divided into the death group(n=36)and the survival group(n=23).The differences in baseline data were analyzed,and multivariate logistic regression was performed to identify the influencing factors of 28-day mortality in patients with VAECPR.The receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of SAVE score,24-h lactate and their combined detection for predicting 28-day mortality risk in patients with ECPR.Results The 28-day survival rate of patients with ECPR was 39%(23/59).SAVE score of the death group was significantly lower than that of the survival group(-11.67±4.60 vs.-2.43±4.77,P<0.001),and the 24-h lactate in the death group was significantly higher than that in the survival group[5.94(3.37,12.40)mmol/L vs.1.65(1.07,3.15)mmol/L,P<0.001].Multivariate logistic regression analysis showed that SAVE score(OR=0.703,95%CI:0.566-0.873,P=0.001)and 24-h lactate(OR=1.608,95%CI:1.025-2.523,P=0.039)were independent influencing factors of 28-day mortality in ECPR patients.ROC curve analysis showed that the best cut-off value of SAVE score was-6,the sensitivity was 78.30%and specificity was 91.70%.The best cutoff value of 24-h lactate was 4.7 mmol/L,the sensitivity was 63.90%and specificity was 100.00%.The sensitivity and specificity of the combined detection of SAVE score and 24-h lactate were 82.60%and 100.00%,respectively.The area under the curve(AUC)of SAVE score combined with 24-h lactate for predicting the 28-day mortality risk in patients with ECPR was larger than that of SAVE score and 24-h lactate alone(0.952 vs.0.917;0.952 vs.0.84
作者
邹乐
朱轶
张忠满
安迪
夏雨
丁涛
时育彤
梅勇
吕金如
李伟
陈旭锋
Zou Yue;Zhu Yi;Zhang Zhongman;An Di;Xia Yu;Ding Tao;Shi Yutong;Mei Yong;Lv Jinru;Li Wei;ChenXufeng(Emergency Medicine Center,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1486-1490,共5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)。
