动态脉压和血管加压工具在重症监护病房脓毒症患者预后预测中的应用。
Application of dynamic pulse pressure and vasopressor tools for predicting outcomes in patients with sepsis in intensive care units.
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
出版信息
J Crit Care. 2019 Aug;52:156-162. doi: 10.1016/j.jcrc.2019.05.003. Epub 2019 May 3.
PURPOSE
We aimed to determine whether the combination of dynamic pulse pressure and vasopressor (DPV) use is applicable for mortality risk stratification in patients with severe sepsis. We proposed the use of the DPV tool and compared it with traditional sepsis severity indices.
MATERIALS AND METHODS
All adult patients who met the sepsis criteria of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) between August 2013 and January 2017 were eligible for the study. Patients who expired within 3 days of admission to the intensive care unit (ICU) were excluded. The primary outcomes were 7-day and 28-day mortality.
RESULTS
The study participants included 757 consecutive adult patients. A subpopulation of 155 patients underwent immune profiling assays on days 1, 3, and 7 of ICU admission. The DPV tool had a better performance for predicting 7-day mortality (area under curve, AUC: 0.70), followed by the Sequential Organ Failure Assessment (SOFA) (AUC: 0.64), the plus pulse pressure (AUC: 0.64). For predicting 28-day mortality, the DPV tool was not inferior to the SOFA (AUC: 0.61), DPV tool (AUC: 0.59).
CONCLUSIONS
The DPV tool can be applied for 7-day and 28-day mortality risk prediction in patients with sepsis.
目的
我们旨在确定动态脉压与血管加压药（DPV）联合应用是否适用于严重脓毒症患者的死亡风险分层。我们提出使用 DPV 工具，并将其与传统的脓毒症严重程度指数进行比较。
材料和方法
所有符合 2013 年 8 月至 2017 年 1 月第三届国际脓毒症和脓毒性休克定义共识（Sepsis-3）脓毒症标准的成年患者均有资格参加研究。入院重症监护病房（ICU）后 3 天内死亡的患者被排除在外。主要结局是 7 天和 28 天死亡率。
结果
本研究纳入了 757 例连续的成年患者。155 例患者在 ICU 入院第 1、3 和 7 天进行了免疫谱分析。DPV 工具在预测 7 天死亡率方面表现更好（曲线下面积，AUC：0.70），其次是序贯器官衰竭评估（SOFA）（AUC：0.64）和加脉压（AUC：0.64）。对于预测 28 天死亡率，DPV 工具与 SOFA 无差异（AUC：0.61），DPV 工具（AUC：0.59）。
结论
DPV 工具可用于预测脓毒症患者的 7 天和 28 天死亡风险。
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