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Received:June 18, 2023 Published Online:October 20, 2023
Received:June 18, 2023 Published Online:October 20, 2023
中文摘要: 目的 探讨血钙、毛细血管渗漏指数(CLI)与脓毒性休克患者早期预后的相关性及血钙联合CLI对脓毒性休克早期预后的预测价值。
方法 采用回顾性研究方法，选取2021年1月至2022年10月收住安庆市立医院重症医学科的脓毒性休克患者109例,记录患者的性别、年龄、感染部位和入科24 h内血钙、白蛋白（ALB）及C反应蛋白（CRP）检测值，计算急性生理与慢性健康状况Ⅱ（APACHE Ⅱ）评分和CLI。根据患者28 d内的预后分为死亡组(n=39)、存活组(n=70)，比较两组患者各指标的差异；Spearman相关分析血钙、CLI与APACHE Ⅱ的相关性；logistic回归和受试者工作特征（ROC）曲线分别评价脓毒性休克患者早期预后的危险因素，及各指标对患者早期预后的预测效能。
结果 与存活组相比，死亡组血钙［（2.00±0.22）mmol/L vs (2.14±0.17)mmol/L, t=3.414, P＜0.01］和ALB水平更低（P＜0.05），APACHE Ⅱ评分、CLI更高（P＜0.01）；血钙分别与APACHE Ⅱ评分、CLI呈负相关（r=-0.302、 -0.371, P＜0.01），CLI与APACHE Ⅱ评分呈正相关（r=0.316, P＜0.01）。CRP、CLI、APACHE Ⅱ评分均是脓毒性休克患者28 d内死亡的独立影响因素（P＜0.05）。ROC曲线分析显示，血钙联合CLI对脓毒性休克患者28 d预后的预测价值最大，ROC曲线下面积（AUC）为0.775（95%CI: 0.685~0.866），敏感度为74.4%，特异度为70.0%。
结论 血钙、CLI是评估脓毒性休克患者早期预后的有效指标，二者联合应用具有更高的预测价值。
Abstract:ObjectiveTo investigate the correlation between serum calcium, capillary leakage index (CLI) and early prognosis of patients with septic shock, and the predictive value of serum calcium combined with CLI in early prognosis of septic shock.
Methods A retrospective study was conducted to select 109 patients with septic shock admitted to the ICU of Anqing Municipal Hospital from January 2021 to October 2022. Gender, age, site of infection and serum calcium, albumin (ALB) and C-reactive protein (CRP) within 24 hours of admission were recorded ,and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores and CLI were calculated. According to their prognosis within 28 days, the patients were divided into death group (n=39) and survival group (n=70) to compare the differences of the above indexes between two groups. Spearman analysis was used to analyze the correlation between serum calcium, CLI and APACHE Ⅱ. Logistic regression analysis and receivers operating characteristics (ROC) curve were used to evaluate the risk factors of early prognosis of septic shock patients and the predictive efficacy of each indicator for early prognosis of patients.
Results Compared with the survival group, the death group had lower serum calcium level ［（2.00±0.22）mmol/L vs (2.14±0.17)mmol/L, t=3.414, P＜0.01］ and lower ALB level(P＜0.05), higher APACHE Ⅱ score and higher CLI (P＜0.01). Serum calcium was negatively correlated with APACHE Ⅱ score and CLI (r=-0.302, -0.371, P＜0.01), respectively, while CLI was positively correlated with APACHE Ⅱ score (r=0.316，P＜0.01). CRP, CLI and APACHE Ⅱ scores were the independent influencing factors for death within 28 days in septic shock patients (P＜0.05). ROC curve analysis showed that serum calcium combined with CLI had the greatest prognostic value for 28-day prognosis of patients with septic shock. The area under ROC curve (AUC) was 0.775 (95%CI: 0.685-0.866), with sensitivity of 74.4% and specificity of 70.0%.
Conclusion Serum calcium and CLI are effective indicators to evaluate the early prognosis of patients with septic shock, and their combined application has higher predictive value.
文章编号： 中图分类号：R631+.4 文献标志码：A
基金项目:安徽省医学会急诊医学临床研究项目（Ky2021016）
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