摘要
目的评估脓毒症(sepsis)患者血栓弹力图(thromboela-stogram,TEG)、凝血功能与平均血小板体积(mean platelet volume,MPV)/血小板计数(platelet count,PLT)比值水平差异与近期预后的价值。方法回顾性分析在2020年1月至2021年9月在徐州医科大学附属医院入住的sepsis患者271例,记录患者相关临床数据,并计算SOFA评分和APACHEⅡ评分,在28 d内进行随访并评估其预后,并以此分为生存组和死亡组,比较两组TEG、凝血功能与MPV/PLT比值的差异,通过Logistic回归分析确认影响预后的独立预测因素为Angle、凝血指数(coagulation index,CI)、抗凝血酶原Ⅲ活性(antithrombinⅢ,AT-Ⅲ)、D-二聚体(D-Dimer,D-Di)、MPV/PLT,建立Angle+CI+AT-Ⅲ+D-Di+MPV/PLT的组合,绘制受试者工作特征曲线(ROC曲线),评估Angle、CI、AT-Ⅲ、D-Di联合MPV/PLT对sepsis患者预后的价值。结果sepsis患者病死率为42.4%。①死亡组患者D-Di、MPV/PLT均明显高于生存组,差异有统计学意义;死亡组患者Angle、CI、AT-III均明显低于生存组,差异有统计学意义。②Logistic回归分析显示Angle、CI、AT-Ⅲ、D-Di、MPV/PLT是影响sepsis患者预后的独立预测因素(均P<0.05)。③Angle+CI+AT-Ⅲ+D-Di+MPV/PLT的联合检测评估sepsis 28 d预后的曲线下面积为0.931,大于单独使用Angle、CI、AT-Ⅲ、D-Di、MPV/PLT的面积(0.755、0.790、0.776、0.729、0.746),且Angle+CI+AT-Ⅲ+D-Di+MPV/PLT的联合的灵敏度为83.5%,特异度为91.0%,也较单独指标有所提高。结论Angle、CI、AT-Ⅲ、D-Di、MPV/PLT是影响sepsis患者预后的独立预测因素;Angle+CI+AT-Ⅲ+D-Di+MPV/PLT联合检测评估sepsis预后的灵敏度及特异度均较高。
Objective To compare the value of difference between thromboelastogram(TEG),coagulation function and mean platelet volume(MPV)/platelet count(PLT)ratio in sepsis patients with shortterm prognosis.Methods A total of 271 patients with sepsis admitted to the Affi liated Hospital of Xuzhou Medical University from January 2020 to September 2021 were retrospectively analyzed.The clinical data of the patients were recorded,and the SOFA score and APACHEⅡscore were calculated.The patients were followed up within 28 days and were divided into the survival group and death group.The TEG,coagulation function and MPV/PLT ratio were compared between the two groups.The independent prognostic factors of Angle,CI,AT-Ⅲ,D-Di and MPV/PLT ratio were confi rmed by Logistic regression analysis.The combination of Angle+CI+AT-Ⅲ+D-Di+MPV/PLT ratio was established,and the ROC curve was drawn to evaluate the prognostic value of Angle,CI,AT-Ⅲand D-Di combined with MPV/PLT ratio in patients with sepsis.Results The mortality rate of patients with sepsis was 42.4%.The D-Di and MPV/PLT ratio of the death group were signifi cantly higher than those of the survival group,and the differences were statistically signifi cant.Angle,CI and AT-III in the death group were significantly lower than those in the survival group,and the differences were statistically signifi cant.Logistic regression analysis showed that Angle,CI,AT-Ⅲ,D-Di and MPV/PLT ratio were independent predictors of the prognosis of patients with sepsis(all P<0.05).The area under the curve of the combined detection of Angle,CI,AT-Ⅲ,D-DI and MPV/PLT ratio to evaluate the prognosis of sepsis at 28 days was 0.931,which was larger than that of Angle,CI,AT-Ⅲ,D-Di and MPV/PLT ratio alone(0.755,0.790,0.776,0.729 and 0.746).The sensitivity and specifi city of the combination of Angle,CI,AT-Ⅲ,D-Di and MPV/PLT ratio were 83.5%and 91.0%,which were also higher than those of the single index.Conclusions Angle,CI,AT-Ⅲ,D-Di and MPV/PLT ratio are independent prognostic predictors of patients with sepsis.The combination of Angle,CI,AT-Ⅲ,D-Di and MPV/PLT ratio has high sensitivity and specifi city in evaluating the prognosis of sepsis.
作者
印明珠
孙明
燕宪亮
Yin Mingzhu;Sun Ming;Yan Xianliang(Emergency Medicine Department,the Affifiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Graduate School of Xuzhou Medical University,Xuzhou 220002,China;Department of Emergency,Suqian Hospital Affiliated to Xuzhou Medical University,Suqian 223800,China;Jiangsu Institute of Health Emergency,Xuzhou 221002,China;Emergency Medicine Department,Suining County People's Hospital,Xuzhou 221299,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2022年第10期1347-1352,共6页
Chinese Journal of Emergency Medicine
基金
徐州市国家临床重点专科培训项目(2018ZK004)
江苏省卫生健康委“六个一”工程科研项目(LGY2019085)
徐医附院优秀中青年人才项目资助(2019128009)
国家重点研发计划(2020YFC1512704)。
