凝血酶原时间-国际标准化比值对接受多黏菌素 B 药盒血液灌流的脓毒性休克患者结局的影响。

Impact of prothrombin time-International Normalized Ratio on outcome of patients with septic shock receiving polymyxin B cartridge hemoperfusion.

机构信息

Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.

出版信息

Surgery. 2014 Jul;156(1):168-75. doi: 10.1016/j.surg.2014.03.009. Epub 2014 Mar 15.

DOI:10.1016/j.surg.2014.03.009

PMID:24929766

Abstract

BACKGROUND

Although most patients with septic shock have a poor outcome, some may survive after blood purification treatment such as polymyxin B cartridge hemoperfusion (PMX).

OBJECTIVE

To explore the most significant characteristic associated with 28-day mortality in patients with septic shock receiving PMX.

METHODS

Between April 2006 and March 2008, 116 patients with septic shock who had received PMX in a prospectively collected multicenter collaborative study were enrolled. Uni- and multivariate analyses using the Cox proportional hazard model were performed to assess the most significant clinical characteristic that was associated with 28-day mortality.

RESULTS

Among 33 clinicolaboratory characteristics, receiver operating characteristic (ROC) curve analyses selected 12 characteristics with recommended cutoff values such as HCO(3)(-) (≤19.8/>19.8; mEq/L), base excess (≤-5.35/>-5.35; mEq/L), diastolic blood pressure (≤48/>48 mmHg), mean arterial pressure (≤73/>73 mmHg), pH (≤7.29/>7.29), interleukin-6 (≤19,150/>19,150 pg/dL), prothrombin time-International Normalized Ratio (PT-INR; ≤2.05/>2.05), predictive value of Acute Physiology and Chronic Health Evaluation II (APACHE II; ≤0.4/>0.4), pyruvate (≤1.82/>1.82 mg/dL), APACHE II score (≤21/>21), acetate/pyruvate ratio (≤19/>19), and acetate (≤44.8/>44.8 mg/dL) on the basis of large area under the ROC curves for 28-day mortality. The results of uni- and multivariate analyses using these selected characteristics revealed that only PT-INR (≤2.05/>2.05; hazard ratio, 2.823; 95% CI, 1.243-6.412; P = .013) was associated with 28-day mortality. Survival curve analysis demonstrated a significant difference in 28-day mortality between patients with lower (≤2.05) and higher (>2.05) PT-INR (P < .001).

CONCLUSION

Prolonged PT-INR is an independent risk factor for 28-day mortality in patients receiving PMX for septic shock.

摘要

背景

尽管大多数脓毒性休克患者预后较差，但一些患者在接受多黏菌素 B 吸附柱血液灌流（PMX）等血液净化治疗后可能存活。

目的

探讨脓毒性休克患者接受 PMX 治疗后 28 天死亡率的最重要相关特征。

方法

2006 年 4 月至 2008 年 3 月，前瞻性收集多中心协作研究中 116 例接受 PMX 治疗的脓毒性休克患者，采用单因素和多因素 Cox 比例风险模型分析评估与 28 天死亡率相关的最重要临床特征。

结果

在 33 项临床实验室特征中，接受者操作特征（ROC）曲线分析选择了 12 项具有推荐截断值的特征，如 HCO₃^-（≤19.8/>19.8；mEq/L）、碱剩余（≤-5.35/>-5.35；mEq/L）、舒张压（≤48/>48 mmHg）、平均动脉压（≤73/>73 mmHg）、pH（≤7.29/>7.29）、白细胞介素-6（≤19,150/>19,150 pg/dL）、凝血酶原时间-国际标准化比值（PT-INR；≤2.05/>2.05）、急性生理学和慢性健康评估 II 预测值（APACHE II；≤0.4/>0.4）、丙酮酸（≤1.82/>1.82 mg/dL）、APACHE II 评分（≤21/>21）、乙酸/丙酮酸比值（≤19/>19）和乙酸（≤44.8/>44.8 mg/dL）。这些特征的 ROC 曲线下面积较大，提示其与 28 天死亡率相关。单因素和多因素分析结果显示，只有 PT-INR（≤2.05/>2.05；风险比，2.823；95%CI，1.243-6.412；P =.013）与 28 天死亡率相关。生存曲线分析显示，PT-INR 较低（≤2.05）和较高（>2.05）的患者 28 天死亡率差异有统计学意义（P <.001）。