Wang Jing, He Lisha, Jin Zhiyan, Lu Guoguang, Yu Sufei, Hu Lingling, Fang Meidan, Jin Xiaxia
Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Taizhou, Zhejiang Province, People's Republic of China.
Department of Ultrasound, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Taizhou, Zhejiang Province, People's Republic of China.
Infect Drug Resist. 2024 Mar 26;17:1199-1213. doi: 10.2147/IDR.S442169. eCollection 2024.
To explore the early predictors and their predicting value of 28-day mortality in sepsis patients and to investigate the possible causes of death.
127 sepsis patients were included, including 79 cases in the survival group and 48 cases in the death group. The results of all patients on admission were recorded. After screening the risk factors of 28-day mortality, the receiver operating characteristic curve (ROC) was used to determine their predictive value for the 28-day mortality rate on admission, and the Kaplan-Meier curve was drawn to compare the 28-day mortality rate between groups. Finally, patients with cytokine and lymphocyte subsets results were included for investigating the possible causes of death through correlation analysis.
APACHE II (acute physiology and chronic health evaluation II), SOFA (Sequential Organ Failure Assessment) and red blood cell distribution width (RDW) were the risk factors for 28-day mortality in sepsis patients (OR: 1.130 vs.1.160 vs.1.530, P < 0.05). The area under the curve (AUC), sensitivity and specificity of APACHE II, SOFA and RDW in predicting the mortality rate at 28 days after admission in sepsis patients were 0.763 vs 0.806 vs 0.723, 79.2% vs 68.8% vs 75.0%, 65.8% vs 89.9% vs 68.4%. The combined predicted AUC was 0.873, the sensitivity was 89.6%, and the specificity was 82.3%. The Kaplan-Meier survival curve showed that the 28-day mortality rates of sepsis patients with APACHE II≥18.5, SOFA≥11.5 and RDW≥13.8 were 58.5%, 80.5% and 59.0%, respectively. In the death group, APACHE II was positively correlated with SOFA, IL-2, and IL-10, and RDW was positively correlated with PLT, TNF-α, CD3 lymphocyte count, and CD8 lymphocyte count.
Sepsis patients with high APACHE II, SOFA and RDW levels at admission have an increased 28-day mortality rate. The elevation of these indicators in dead patients are related to immune dysfunction.
探讨脓毒症患者28天死亡率的早期预测指标及其预测价值，并探究可能的死亡原因。
纳入127例脓毒症患者，其中存活组79例，死亡组48例。记录所有患者入院时的各项结果。筛选出28天死亡率的危险因素后，采用受试者工作特征曲线（ROC）确定其对入院时28天死亡率的预测价值，并绘制Kaplan-Meier曲线比较组间28天死亡率。最后，纳入细胞因子和淋巴细胞亚群结果的患者，通过相关性分析探究可能的死亡原因。
急性生理与慢性健康状况评分系统Ⅱ（APACHE II）、序贯器官衰竭评估（SOFA）及红细胞分布宽度（RDW）是脓毒症患者28天死亡率的危险因素（比值比：1.130对1.160对1.530，P<0.05）。APACHE II、SOFA和RDW预测脓毒症患者入院后28天死亡率的曲线下面积（AUC）、敏感度和特异度分别为0.763对0.806对0.723，79.2%对68.8%对75.0%，65.8%对89.9%对68.4%。联合预测AUC为0.873，敏感度为89.6%，特异度为82.3%。Kaplan-Meier生存曲线显示，APACHE II≥18.5、SOFA≥11.5和RDW≥13.8的脓毒症患者28天死亡率分别为58.5%、80.5%和59.0%。在死亡组中，APACHE II与SOFA、白细胞介素-2（IL-2）和白细胞介素-10（IL-10）呈正相关，RDW与血小板（PLT）、肿瘤坏死因子-α（TNF-α）、CD3淋巴细胞计数及CD8淋巴细胞计数呈正相关。
入院时APACHE II、SOFA和RDW水平高的脓毒症患者28天死亡率增加。死亡患者中这些指标的升高与免疫功能障碍有关。
