摘要
目的探讨联合乳酸和PIRO（易感性、感染打击、反应和器官功能障碍）评分对脓毒症患者进展为多器官功能障碍综合征（MODS）的预测价值，并与降素原（PCT）进行比较，为临床决策提供依据。方法回顾性入选2015年4月至2016年7月在本院急诊就诊的脓毒症患者752例，根据是否合并多器官功能障碍综合征（MODS），分为MODS组（488例）和非MODS组（264例）；按入院后28d内是否存活，分为存活组（477例）和死亡组（275例），分别检测PCT、乳酸水平和计算PIRO评分分值，并根据不同PIRO评分分组比较PCT、乳酸的变化趋势，建立ROC曲线，观察标记物、PIRO评分单独及联合后对预后评估的临床价值。结果脓毒症合并MODS组或死亡组PCT、乳酸水平和PIRO评分明显高于无MODS组和生存组，PIRO评分分值越高，乳酸和PCT越高，呈明显正相关，乳酸联合PIRO评分ROC曲线下面积（AUCs）为0．906，显著高于PCT（0．716）、乳酸（0．851）和PIRO评分（0．840）（P均〈0．05），采用Logistic回归分析结果显示，PCT、乳酸、PIRO评分均进展为MODS的独立影响因子，血乳酸与PIRO评分联合变量预测进展为MODS较单独乳酸和PIRO评分明显增加（P〈0．01）。结论血乳酸联合PIRO评分对于脓毒症患者发生多器官功能障碍综合征具有较好的预测价值。
Objective To investigate the predictive value of serum lactate combined with PIRO （Predisposition, Infection, Response and Organ dysfunction） score in the development of multiple organs dysfunction syndrome （MODS） in septic patients and to study procalcitonin （ PCT）, in order to provide guidelines for clinical care. Methods From April 2015 to July 2016, a total of 752 sepsis patients were enrolled and divided into MODS group （n = 488） and non-MODS group （n = 264） according to the criteria of MODS. At 28 d after admission, these patients were divided into survival group （ n = 477 ） and death group （n = 275）. PCT and lactate levels in serum were measured, and PIRO score of these patients was calculated. Then the differences in levels of PCT and lactate in serum were compared among patients at different PIRO score categories. ROC was constructed to observe the clinical values of the biomarkers, PIRO score and lactate combined with PIRO score in predicting prognosis. Result PCT, lactate levels in serum and PIRO score were significantly higher in MODS group and death group, showing significant positive correlation. The areas under ROC curves （AUCs） of serum lactate combined with PIRO score for predicting MODS were 0. 906, which was significantly higher than that of serum PCT （0. 716）, serum lactate （0. 851 ） and PIRO score （0. 840 ） alone （ all P 〈 0. 05 ）. Serum PCT, serum lactate and PIRO score were the independent predictors of MODS. Conclusions Serum lactate in combination with PIRO score was a valuable indicator in predicting development of MODS in septic patients.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2017年第2期176-180,共5页
Chinese Journal of Emergency Medicine
基金
北京朝阳医院院内基金（YQ2014-30）
