Wu Yin, Ren Jianan, Wang Gefei, Gu Guosheng, Zhou Bo, Ding Chao, Li Guanwei, Liu Song, Wu Xiuwen, Chen Jun, Li Jieshou
Department of Surgery, Jinling Hospital, Medical School of Nanjing University Nanjing, P. R. China.
Int J Clin Exp Med. 2014 Dec 15;7(12):5134-45. eCollection 2014.
The objective of this study was to evaluate the predictive value of serial bilirubin determinations for mortality in enteric fistula (EF) patients complicated with sepsis.
From January 1st, 2012 to January 13rd, 2013, a prospective study enrolling 162 patients was performed. Patients were divided into the survivors group (n = 119) and non-survivors group (n = 43) according to 28-day outcomes. Laboratory variables on day 0, day 3 and day 7 after admission were recorded. DB0 was defined as serum direct bilirubin (DB) value in admission, while ΔDB3 as the changes from DB3 to DB0. The definition applied to other parameters. The results were validated in an independent cohort of 116 patients.
Compared with survivors, non-survivors had significantly higher DB7 (23.1 ± 10.6 vs. 11.2 ± 1.1, P < 0.001) and procalcitonin (PCT7) (5.2 ± 2.8 vs. 1.7 ± 0.3 P = 0.006). ROC analysis showed that DB7 > 12.8 μmol/L and ΔDB7 > 7.3 μmol/L were reliable predictors (DB7: 86.4% sensitivity, 88.6% specificity (area under the curve (AUC): 0.881, P < 0.001; ΔDB7: 84.4% sensitivity, 85.1% specificity, AUC: 0.865, P < 0.001) for mortality.The combination form (DB7 > 12.8 μmol/L + ΔPCT7 < 5.3 ng/ml) had greatest predictive value (AUC: 0.894, P < 0.001). Their predictive values were confirmed in the validation cohort.
Serum direct bilirubin was a reliable predictor for mortality in enteric fistula patients, which should be paid close attention in the critical care.
本研究旨在评估连续胆红素测定对并发脓毒症的肠瘘（EF）患者死亡率的预测价值。
2012年1月1日至2013年1月13日，进行了一项纳入162例患者的前瞻性研究。根据28天的结局将患者分为存活组（n = 119）和非存活组（n = 43）。记录入院后第0天、第3天和第7天的实验室变量。DB0定义为入院时血清直接胆红素（DB）值，而ΔDB3定义为DB3相对于DB0的变化。该定义适用于其他参数。结果在116例患者的独立队列中得到验证。
与存活者相比，非存活者的DB7（23.1±10.6对11.2±1.1，P <0.001）和降钙素原（PCT7）（5.2±2.8对1.7±0.3，P = 0.006）显著更高。ROC分析表明，DB7> 12.8 μmol/L和ΔDB7> 7.3 μmol/L是死亡率的可靠预测指标（DB7：敏感性86.4%，特异性88.6%（曲线下面积（AUC）：0.881，P <0.001；ΔDB7：敏感性84.4%，特异性85.1%，AUC：0.865，P <0.001））。联合形式（DB7> 12.8 μmol/L +ΔPCT7 <5.3 ng/ml）具有最大的预测价值（AUC：0.894，P <0.001）。它们的预测价值在验证队列中得到证实。
血清直接胆红素是肠瘘患者死亡率的可靠预测指标，在重症监护中应予以密切关注。
