摘要
目的探讨脂蛋白对重症患者进展为慢性危重症(CCI)的预测价值。方法采用回顾性队列研究方法,分析2020年1月1日至2022年12月31日南京鼓楼医院重症医学科收治患者的临床资料。收集患者入重症监护病房(ICU)1、3、7、14、21 d高密度脂蛋白(HDL)、低密度脂蛋白(LDL)及载脂蛋白(ApoA-Ⅰ、ApoB)水平等临床数据,并记录患者是否进展为CCI,CCI定义为ICU住院时间≥14 d且持续存在器官功能障碍〔序贯器官衰竭评分(SOFA)≥2分〕。比较是否进展为CCI两组患者各类脂蛋白指标的差异;采用多因素Logistic回归法分析重症患者进展为CCI的危险因素;绘制受试者工作特征曲线(ROC曲线),评价脂蛋白对重症患者进展为CCI的预测价值。结果最终共200例患者纳入分析,其中137例(68.5%)进展为CCI,63例(31.5%)未进展为CCI;CCI组患者各类脂蛋白指标经过急性期后呈下降趋势,而非CCI组各类脂蛋白指标呈上升趋势。CCI组患者各时间点HDL、LDL、ApoA-Ⅰ、ApoB均显著低于非CCI组;CCI组7 d HDL明显低于非CCI组〔mmol/L:0.44(0.31,0.61)比0.67(0.49,0.75),P<0.01〕。多因素Logistic回归分析显示,7 d HDL为重症患者进展为CCI的独立危险因素〔优势比(OR)=0.033,95%可信区间(95%CI)为0.004~0.282,P=0.002〕。ROC曲线分析显示,7 d HDL预测重症患者进展为CCI的ROC曲线下面积(AUC)为0.702,95%CI为0.625~0.779,P<0.001;当最佳截断值为0.59 mmol/L时,敏感度为69.8%,特异度为72.4%。结论低水平脂蛋白与重症患者病情进展密切相关,且7 d HDL对重症患者进展为CCI具有一定的预测价值;连续观察脂蛋白水平变化趋势有助于判断重症患者的病情进展。
Objective To explore the predictive value of lipoproteins on the progression of critically ill patients to chronic critical illness(CCI).Methods A retrospective cohort study was conducted to analyze clinical data of patients admitted to the intensive care unit(ICU)of Nanjing Drum Tower Hospital from January 1,2020,to December 31,2022.The levels of high-density lipoprotein(HDL),low-density lipoprotein(LDL)and apolipoproteins(ApoA-Ⅰ,ApoB)at 1,3,7,14 and 21 days after admission to ICU were collected.The progression to CCI was recorded.CCI was defined as the length of ICU stay≥14 days with sustained organ dysfunction[sequential organ failure assessment(SOFA)score≥2].Differences in lipoprotein levels between the patients with and without CCI were compared.Multivariate Logistic regression was used to analyze risk factors for critically ill patients progressing to CCI.Receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of lipoproteins on critically ill patients progressing to CCI.Results A total of 200 patients were enrolled in the final analysis.137 patients(68.5%)progressed to CCI,and 63 patients(31.5%)did not.The lipoprotein indicators in the CCI group showed a decrease after the acute phase,while the lipoprotein indicators in the non-CCI group showed an increase.The levels of HDL,LDL,ApoA-Ⅰ,and ApoB at various time points in the CCI group were significantly lower than those in the non-CCI group.HDL at 7 days in the CCI group was significantly lower than that in the non-CCI group[mmol/L:0.44(0.31,0.61)vs.0.67(0.49,0.75),P<0.01].Multivariate Logistic regression analysis showed that 7-day HDL was an independent risk factor for critically ill patients progressing to CCI[odds ratio(OR)=0.033,95%confidence interval(95%CI)was 0.004-0.282,P=0.002].ROC curve analysis showed that the area under the ROC curve(AUC)of 7-day HDL for predicting critically ill patients progressing to CCI was 0.702,with a 95%CI of 0.625-0.779,P<0.001.When the optimal cut-off value was 0.59 mmol/L,the s
作者
黄世杰
陈显成
陈鸣
韩炎榆
段剑峰
刘加莉
朱章华
虞文魁
Huang Shijie;Chen Xiancheng;Chen Ming;Han Yanyu;Duan Jianfeng;Liu Jiali;Zhu Zhanghua;Yu Wenkui(Department of Intensive Care Unit,Drum Tower Clinical Medical College,Nanjing University of Chinese Medicine(the Affiliated Hospital of Nanjing University Medical School,Nanjing Drum Tower Hospital),Nanjing 210008,Jiangsu,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2024年第1期78-81,共4页
Chinese Critical Care Medicine
基金
国家自然科学基金(81701953)
江苏省卓越博士后计划项目(2022ZB689)。
关键词
重症监护病房
慢性危重症
脂蛋白
预后
Intensive care unit
Chronic critical illness
Lipoprotein
Prognosis
