Liu Jiangping, Li Yajun, Zheng Yawen, Zhang Cuijie, Huang Lihua, Ning Xiaopeng, Wang Wenfei, Dou Qingli
Department of Emergency Medicine, People's Hospital of Shenzhen Baoan District (the Second Affiliated Hospital of Shenzhen University), Shenzhen 518101, Guangdong, China. Corresponding author: Dou Qingli, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Dec;36(12):1233-1237. doi: 10.3760/cma.j.cn121430-20240718-00614.
To evaluate the predictive value of plasma heparin-binding protein (HBP) combined with albumin (Alb) for predicting 28-day mortality in patients with sepsis.
The clinical data of patients with sepsis admitted to the emergency intensive care unit (EICU) of the People's Hospital of Shenzhen Baoan District from March 2020 to March 2024 were retrospectively analyzed. The study began at the time of the first diagnosis of sepsis upon EICU admission and ended upon patient death or at 28 days. The gender, age, length of stay in EICU, underlying diseases, and infection sites were recorded. Within 24 hours of sepsis diagnosis, blood culture results, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), blood lactate acid (Lac), HBP, Alb, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), mortality in emergency department sepsis score (MEDS), modified early warning score (MEWS), number of organ failures, use of vasopressors, application of mechanical ventilation, renal replacement therapy, and 28-day prognosis were recorded, the differences in these indicators between two groups were compared. Univariate and multivariate Logistic regression analyses were used to analyze the risk factors of 28-day mortality in patients with sepsis. Receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the early predictive value of various risk factors for 28-day mortality in patients with sepsis.
A total of 300 patients with sepsis were included, with 16 excluded, resulting in 284 patients being analyzed. Among them, 191 survived and 93 died within 28 days. There were no statistically significant differences between the two groups in terms of gender, age, underlying diseases, infection sites, blood culture positivity rate, number of organ failures, and length of stay in EICU. Univariate analysis showed that the rate of vasopressor use, the rate of mechanical ventilation, HBP, PCT, CRP, Lac, SOFA score, APACHE II score, MEDS score, and MEWS score were significantly higher in the death group than those in the survival group, while Alb was significantly lower in the death group than that in the survival group. Multivariate Logistic regression analysis showed that HBP and Alb were independent risk factors for predicting 28-day mortality in patients with sepsis [odds ratio (OR) and 95% confidence interval (95%CI) were 1.093 (0.989-1.128) and 1.174 (1.095-1.259), both P < 0.05]. ROC curve analysis showed that both HBP and Alb had certain predictive value for 28-day mortality in patients with sepsis [AUC and 95%CI were 0.820 (0.717-0.923) and 0.786 (0.682-0.890), both P < 0.05]. When the critical value of HBP was 117.50 μg/L, the sensitivity was 85.90%, and the specificity was 70.50%. When the critical value of Alb was 28.30 g/L, the sensitivity was 69.30%, and the specificity was 81.20%. When the two indexes were combined for diagnosis, the AUC was 0.881 (95%CI was 0.817-0.945, P < 0.001), the sensitivity was 92.70%, and the specificity was 76.80%.
HBP and Alb are independent risk factors for predicting 28-day mortality in patients with sepsis. The combined prediction efficiency of HBP and Alb for 28-day mortality in patients with sepsis is superior to a single indicator.
评估血浆肝素结合蛋白（HBP）联合白蛋白（Alb）对脓毒症患者28天死亡率的预测价值。
回顾性分析2020年3月至2024年3月深圳市宝安区人民医院急诊重症监护病房（EICU）收治的脓毒症患者的临床资料。研究从患者首次诊断脓毒症入住EICU时开始，至患者死亡或28天时结束。记录患者的性别、年龄、EICU住院时间、基础疾病及感染部位。在脓毒症诊断后24小时内，记录血培养结果、白细胞计数（WBC）、C反应蛋白（CRP）、降钙素原（PCT）、血乳酸（Lac）、HBP、Alb、序贯器官衰竭评估（SOFA）、急性生理与慢性健康状况评分II（APACHE II）、急诊脓毒症死亡率评分（MEDS）、改良早期预警评分（MEWS）、器官衰竭数量、血管活性药物使用情况、机械通气应用情况、肾脏替代治疗情况及28天预后，比较两组这些指标的差异。采用单因素和多因素Logistic回归分析脓毒症患者28天死亡的危险因素。绘制受试者工作特征曲线（ROC曲线），计算ROC曲线下面积（AUC），评估各危险因素对脓毒症患者28天死亡率的早期预测价值。
共纳入300例脓毒症患者，排除16例，最终纳入分析284例。其中，191例存活，93例在28天内死亡。两组在性别、年龄、基础疾病、感染部位、血培养阳性率、器官衰竭数量及EICU住院时间方面差异无统计学意义。单因素分析显示，死亡组血管活性药物使用率、机械通气率、HBP、PCT、CRP、Lac、SOFA评分、APACHE II评分、MEDS评分及MEWS评分均显著高于存活组，而死亡组Alb显著低于存活组。多因素Logistic回归分析显示，HBP和Alb是脓毒症患者28天死亡的独立危险因素[比值比（OR）及95%置信区间（95%CI）分别为1.093（0.989 - 1.128）和1.174（1.095 - 1.259），均P < 0.05]。ROC曲线分析显示，HBP和Alb对脓毒症患者28天死亡率均有一定预测价值[AUC及95%CI分别为0.820（0.717 - 0.923）和0.786（0.682 - 0.890），均P < 0.05]。当HBP临界值为117.50μg/L时，敏感度为85.90%，特异度为70.50%。当Alb临界值为28.30g/L时，敏感度为69.30%，特异度为81.20%。当两项指标联合诊断时，AUC为0.881（95%CI为0.817 - 0.945，P < 0.001），敏感度为92.70%，特异度为76.
