Peng Longping, Yuan Xiangyi, Li Lele, Liu Jueting, Ma Jian, Zhong Shan
Orthopaedics, Bayi Orthopaedics Hospital, Chengdu, Sichuan, China.
Medicine (Baltimore). 2025 Jun 6;104(23):e42547. doi: 10.1097/MD.0000000000042547.
This study investigates the value of combining N-terminal pro-B-type natriuretic peptide (NT-proBNP), neutrophil-to-lymphocyte ratio (NLR), angiopoietin-1 (Ang-1) with the acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores for the assessment of 28-day mortality in septic shock. This retrospective study enrolled 121 hospitalized patients with septic shock admitted from February 2022 to February 2023 and followed them up. They were grouped based on whether they died within 28 days. 44 patients who died were included in the death group, while the other 77 patients were included in the survival group. Clinical data differences between the groups were compared, and the predictive value of NT-proBNP, NLR, Ang-1, APACHE II, and SOFA scores for mortality within 28 days was explored. The patients in the death group and the survival group showed no differences in gender, past medical history (hypertension, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease), recent surgical history, age, shock index, and oxygenation index (P > .05). However, the levels of blood creatinine and lactate were higher in the death group compared to the survival group (P < .05). The levels of NT-proBNP, NLR, Ang-1, as well as APACHE II and SOFA scores were higher in the deceased group compared to the survival group (P < .05). Multiple-factor logistic regression analysis indicated that creatinine, NT-proBNP, NLR, Ang-1, APACHE II score, and SOFA score all significantly influenced the survival status of patients (P < .05). Based on the aforementioned multifactorial analysis results, a logistic regression model was established. Using this model as the independent variable, ROC curve analysis was conducted with patient mortality within 28 days as the dependent variable. The area under the curve (AUC) value was found to be 0.844, with a 95% CI of 0.772 to 0.916. Sensitivity was 0.841, and specificity was 0.701. The optimal cutoff value was determined to be 123.56. The model exhibited good fit (Hosmer-Lemeshow χ2 = 3.458, P = .788). The combined analysis of NT-proBNP, NLR, Ang-1 levels, along with APACHE II and SOFA scores, can effectively predict the 28-day mortality risk in patients with septic shock. These indicators have important clinical value in early identification of high-risk patients and guiding treatment decisions.
本研究探讨将N末端B型利钠肽原（NT-proBNP）、中性粒细胞与淋巴细胞比值（NLR）、血管生成素-1（Ang-1）与急性生理学与慢性健康状况评分系统II（APACHE II）及序贯器官衰竭评估（SOFA）评分相结合，用于评估感染性休克患者28天死亡率的价值。这项回顾性研究纳入了2022年2月至2023年2月期间收治的121例感染性休克住院患者，并对其进行随访。根据患者在28天内是否死亡进行分组。44例死亡患者纳入死亡组，另外77例患者纳入存活组。比较两组之间的临床资料差异，探讨NT-proBNP、NLR、Ang-1、APACHE II及SOFA评分对28天内死亡率的预测价值。死亡组和存活组在性别、既往病史（高血压、糖尿病、脑血管疾病和慢性阻塞性肺疾病）、近期手术史、年龄、休克指数及氧合指数方面无差异（P>0.05）。然而，与存活组相比，死亡组血肌酐和乳酸水平更高（P<0.05）。与存活组相比，死亡组的NT-proBNP、NLR、Ang-1水平以及APACHE II和SOFA评分更高（P<0.05）。多因素逻辑回归分析表明，肌酐、NT-proBNP、NLR、Ang-1、APACHE II评分及SOFA评分均对患者的生存状况有显著影响（P<0.05）。基于上述多因素分析结果，建立了逻辑回归模型。以该模型为自变量，以患者28天内死亡率为因变量进行ROC曲线分析。曲线下面积（AUC）值为0.844，95%置信区间为0.772至0.916。灵敏度为0.841，特异度为0.701。确定最佳截断值为123.56。该模型拟合良好（Hosmer-Lemeshow χ2=3.458，P=0.788）。联合分析NT-proBNP、NLR、Ang-1水平以及APACHE II和SOFA评分，可有效预测感染性休克患者28天死亡风险。这些指标在早期识别高危患者及指导治疗决策方面具有重要的临床价值。
