摘要
目的 探讨全身免疫炎症指数(systemic immune-inflammation index,SII)与预后营养指数(prognostic nutritional index,PNI)对老年患者脓毒症心肌病(sepsis-induced cardiomyopathy,SIC)的诊断及预后的临床价值。方法 回顾性纳入2020年1月至2025年2月就诊于北京中医药大学东直门医院急诊重症监护病房收治的老年脓毒症患者168例,根据超声心动图结果分为SIC组77例与对照组91例,以28 d生存情况将SIC组患者分为生存组35例和死亡组42例。收集患者临床资料,采用ROC曲线评估各项指标对SIC患者预后的预测效能。结果 SIC组高血压、冠心病、肾功能不全比例及呼吸频率明显高于对照组(P<0.05,P<0.01)。SII、年龄、序贯器官衰竭评分是脓毒症患者发生心功能障碍的危险因素(P<0.05)。死亡组心率、呼吸频率明显高于生存组(P<0.01)。PNI是SIC患者28 d内死亡的独立危险因素(HR=0.919,95%CI:0.861~0.980,P<0.05)。ROC曲线分析显示,SII/PNI比值预测SIC患者死亡的曲线下面积为0.730。结论 高SII是脓毒症患者发展为SIC的独立危险因素,低PNI是SIC患者死亡的独立预测因素,SII/PNI对SIC患者的死亡有预测价值。
Objective To investigate the clinical value of systemic immune-inflammation index(SII)combined with prognostic nutritional index(PNI)in the diagnosis and prognosis of sepsis-induced cardiomyopathy(SIC)in the elderly.Methods A retrospective analysis was conducted on 168 elderly patients with sepsis admitted to Emergency ICU of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2020 to February 2025.Based on the results of echocardiography,they were divided into an SIC group(77 cases)and a control group(91 cases).The patients in the SIC group were further assigned into a survival subgroup(n=35)and a death subgroup(n=42)based on their 28-day outcomes.Clinical data were collected,and ROC curve analysis and Cox regression analysis were performed to evaluate the predictive efficiency of SII,PNI and other indicators for the prognosis of the SIC patients.Results The SIC group exhibited significantly higher ratios of hypertension,coronary heart disease,and renal dysfunction,and higher respiratory rate than the control group(P<0.05,P<0.01).SII,age and sequential organ failure assessment(SOFA)score were risk factors for cardiac dysfunction in sepsis patients(P<0.05).Obviously higher heart rate and respiratory rate were observed in the death subgroup than the survival subgroup(P<0.01).PNI was an independent risk factor for 28-day death in the SIC patients(HR=0.919,95%CI:0.861-0.980,P<0.05).ROC curve analysis revealed that the AUC value of SII/PNI ratio in predicting the death in SIC patients was 0.730.Conclusion High SII is an independent risk factor for developing SIC in patients with sepsis,and low PNI is an independent predictor of death in patients with SIC.SII/PNI ratio has certain predictive value for death in SIC patients.
作者
李硕
张源波
朱瑞
王子敬
洪学远
姬泉雅
刘宇
LI Shuo;ZHANG Yuanbo;ZHU Rui;WANG Zijing;HONG Xueyuan;JI Quanya;LIU Yu(Department of Emergency,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Department of Cardiology,Seventh Medical Center,Chinese PLA General Hospital,Beijing 100700,China)
出处
《中华老年心脑血管病杂志》
北大核心
2026年第2期200-203,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
北京中医药大学东直门医院重大及疑难疾病循证研究(DZMG-ZLZX-25024)
吴阶平医学基金会临床科研专项资助基金(320.6750.2022-16-11)。
