目的 探讨血清降钙素原(PCT),高敏C反应蛋白(hs-CRP)和白介素-6(IL-6)联合检测对脓毒症患者短期(28 d内)死亡风险的预测价值。方法 回顾性分析2019-12至2021-12广州医科大学附属第四医院急诊科及重症医学科收治的60例脓毒症患者的临床资料。分析脓毒症患者的一般资料及实验室血清指标,并利用logistic回归分析确定脓毒症患者死亡风险因子,并通过绘制受试者工作特征(ROC)曲线评估相关指标对死亡的预测能力。结果 入院28 d内存活33例(存活组),死亡27例(死亡组);死亡组的年龄及血清PCT,hs-CRP和IL-6明显高于存活组,差异有统计学意义(P<0.05)。多因素logistic回归分析表明,PCT(OR=1.288)、hs-CRP(OR=1.195)和IL-6(OR=1.184)均是脓毒症患者28 d内死亡的独立影响因素(P<0.05)。且血清PCT,hs-CRP和IL-6及联合检测预测脓毒症患者预后的ROC曲线下面积(AUC)值分别为0.843, 0.829, 0.726和0.938,联合检测的预测能明显高于其他单独检测指标,差异有统计学意义(Z=3.791, 4.069, 5.271,P<0.05),联合检测预测准确度最高。结论 血清PCT,hs-CRP和IL-6均对脓毒症患者的死亡风险评估具有一定的预测价值,但联合检测较单一检测更准确,临床应用价值更高。
Abstract
Objective To explore the application value of serum procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and the combined detection of three indicators in predicting the short-term risk of death in patients with sepsis. Methods The clinical data of 60 patients with sepsis admitted to the Department of emergency and critical care medicine of the Fourth Affiliated Hospital of Guangzhou Medical University from December 2019 to December 2021 were analyzed retrospectively. The general data of sepsis patients and laboratory serum indicators were analyzed, and the risk factors of sepsis patients' death were determined by logistic regression analysis, and the predictive ability of related indicators to death was evaluated by plotting the receiver operating characteristic (ROC) curve. Results Among the 60 patients with sepsis, 33 survived and 27 died within 28 days after admission; The age, serum PCT, hs CRP and IL-6 of the patients in the death group were significantly higher than those in the survival group (all P<0.05). Multivariate logistic regression analysis showed that PCT (OR=1.288), hs CRP (OR=1.195) and IL-6 (OR=1.184) were all independent factors of sepsis patients' death within 28 days (all P<0.05). The area under ROC curve (AUC) values of PCT, hs CRP, IL-6 and combined detection for the prognosis of sepsis patients were 0.843, 0.829, 0.726 and 0.938, respectively. The diagnostic efficiency of combined detection was significantly higher than that of other independent detection indicators (Z=3.791, 4.069, 5.271, P< 0.05), and the diagnostic accuracy of combined detection was the highest. Conclusion Serum PCT, hs CRP and IL-6 have certain predictive value for the risk assessment of death in sepsis patients, and the combined detection significantly improve the diagnostic efficiency of the risk of death in sepsis patients within 28 days.
关键词
降钙素原 /
高敏C反应蛋白 /
白介素-6 /
检测 /
脓毒症 /
预后
Key words
procalcitonin /
high sensitivity c-reactive protein /
interleukin-6 /
detection /
sepsis /
prognosis
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基金
广东省科技计划项目(2017ZC0440);广州医科大学附属第四医院优秀医学人才培育基金(2019YX-01)
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