摘要
目的:探讨ROX-HR指数对于脓毒症患者28 d死亡率的预测价值。方法:选取我院2022年10月—2023年10月收治的178例脓毒症患者和79例脓毒性休克患者,进行回顾性研究。通过入院后2 h内所记录的呼吸、心率、氧饱和度、吸入氧浓度计算ROX-HR指数及ROX指数。记录2 h内最差的ROX-HR指数及ROX指数。采用logistic回归模型确定与脓毒症28 d死亡率相关的独立预测因素。采用受试者工作特征(receiver operator characteristic,ROC)曲线评价ROX-HR指数对脓毒症患者的预测价值。用约登指数确定ROX-HR指数对脓毒症患者死亡率的预测价值。根据约登指数确定的ROX-HR指数最佳截点值(6.3),将所有脓毒症患者分为高ROX-HR指数组(ROX-HR指数≥6.3)和低ROX-HR指数组(ROX-HR指数<6.3),绘制Kaplan-Meier生存曲线分析ROX-HR指数与两组患者生存状态的关系。结果:通过logistic回归分析提示更高的APACHEⅡ评分、乳酸及更低的ROX-HR指数与脓毒症患者的28 d死亡率发生独立相关。通过ROC的结果得出,ROX-HR指数、APACHEⅡ评分、乳酸和ROX指数的ROC曲线下面积(area under curve,AUC)分别为0.722(95%CI:0.641~0.802)、0.758(95%CI:0.685~0.830)、0.674(95%CI:0.585~0.762)和0.684(95%CI:0.600~0.768)。通过Kaplan-Meier生存曲线分析显示,高ROX-HR指数组累计生存率明显高于低ROX-HR指数组(79.37%vs 34.62%,P<0.01)。ROX-HR指数与脓毒性休克患者的28 d死亡率的AUC为0.607。结论:ROX-HR指数在死亡组中明显低于存活组,ROX-HR指数<6.3是脓毒症患者28 d死亡风险的独立预测因素。ROX-HR指数对于脓毒性休克患者的预测能力较差。
Objective:To investigate the predictive value of the ROX-HR index for 28-day mortality in sepsis patients.Methods:A total of 178 patients with sepsis admitted to our hospital from October 2022 to October 2023 were selected for this retrospective study.ROX-HR index and ROX index were calculated from respiration,heart rate,oxygen saturation,and inspired oxygen concentration recorded within 2 hours after admission.The worst ROX-HR index and ROX index within 2 hours were recorded.Logistic regression modeling was used to determine the independent predictors associated with 28-day mortality in sepsis patients.The predictive value of the ROX-HR index for sepsis patients was evaluated using the Receiver operator characteristic(ROC) curve.The predictive value of ROX-HR index for mortality in sepsis patients was determined using the Youden index.Based on the optimal cut-off value of ROX-HR index determined by the Youden index,all sepsis patients were divided into the high ROX-HR index group and the low ROX-HR index,and the Kaplan-Meier survival curves were plotted to analyze the relationship between ROX-HR index and the survival status of the two groups of patients.Results:Higher APACHE Ⅱ score,higher lactate and lower ROX-HR index were suggested to be independently associated with the 28-day mortality in sepsis patients by logistic regression analysis.The results of area under curve(AUC) of ROX-HR index,APACHE Ⅱ,lactate and ROX index were 0.722(95%CI:0.641-0.802) 、0.758(95%CI:0.685-0.830) 、0.674(95%CI:0.585-0.762) and 0.684(95%CI:0.600-0.768),respectively.Patients were categorized into high and low ROX-HR groups based on the best cut-off value(6.3) of ROX-HR for predicting 28-day mortality in sepsis patients,and analysis of the Kaplan-Meier curves showed that the cumulative survival rate in the high ROX-HR index group was significantly higher than that in the low ROX-HR index group(79.37% vs 34.62%,P<0.01).The AUC of ROX-HR index for patients with septic shock was 0.607.Conclusion:ROX-HR index was significantly lower in the death group than in the survival group,and ROX-HR index<6.3 was an independent predictor of 28-day mortality in sepsis patients.The ROX-HR index has poor predictive value in patients with septic shock.
作者
曹卫健
王言理
CAO Weijian;WANG Yanli(Department of Emergency Medicine,the Affiliated Lianyungang Hospital of Xuzhou Medical University,the First People's Hospital of Lianyungang,Lianyungang,Jiangsu,222000,China)
出处
《临床急诊杂志》
CAS
2024年第5期229-234,共6页
Journal of Clinical Emergency
