摘要
目的脓毒症相关肝损伤(SALI)是由于脓毒症引起的全身和微循环变化而发生的。其在新生儿中的预后意义尚不清楚。本研究旨在开发一种预测脓毒症相关肝损伤(SALI)患儿的住院死亡风险模型。方法数据来自重症监护医疗信息集(MIMIC)-Ⅲ数据库,所有符合纳入标准和排除标准的SALI的新生儿都被纳入。根据是否发生SALI分为SALI组和非SALI组,并通过单因素和多因素分析比较了两组之间的结果。结果收集MIMICⅢ数据库2001年至2008年收治的重症新生儿数据共7870例。在这些患儿中,脓毒症新生儿患者1022人,约(8.22%)新生儿脓毒症相关性肝损伤(SALI),共84人。对新生儿SALI组与无SALI组患者的28天生存率进行log rank检验,显示两组患者的28天生存率存在显著差异(χ^(2)=55.924,P<0.001),28天内SALI组的病死率明显高于无SALI组。对发生SALI的新生儿进行单因素和多因素分析,评估得出出生体重、血乳酸和红细胞分布宽度(RDW)是脓毒症合并肝损伤的新生儿的独立危险因素,出生体重OR 3.102(95%CI 1.865~6.214)P=0.0023,血乳酸OR 4.684(95%CI 2.577~7.025)P=0.0016,RDW OR 2.681(95%CI 1.408~6.420)。由出生体重、血乳酸和红细胞分布宽度(RDW)组成模型和常用的危重患者的严重程度评分进行ROC分析,模型AUC 0.834;SOFA评分AUC 0.709,SAPS2评分AUC0.733,与SOFA和SAPS2评分相比,预测模型在预测SALI患者住院死亡风险方面显示出更好的辨别力。死亡组的ICU住院时间明显长于生存组。结论新生儿发生是否发生脓毒症相关性肝损伤(SALI)影响新生儿的生存率。出生体重、血乳酸和红细胞分布宽度(RDW)是脓毒症合并肝损伤的新生儿的独立危险因素,可以帮助临床医生早期识别高危患者,并为临床治疗策略提供参考。
Objective Sepsis-associated liver injury(SALI)occurs as a result of systemic and microcirculatory changes caused by sepsis.Its prognostic significance in neonates is unclear.The aim of this study was to develop a model to predict the risk of in-hospital death in children with sepsis-associated liver injury(SALI).Methods Data were obtained from the Medical Information Collection for Intensive Care(MIMIC)-III database,and all neonates with SALI who met the inclusion and exclusion criteria were included.The groups were divided into SALI and non-SALI groups according to the occurrence of SALI,and the results were compared between the two groups by univariate and multifactorial analyses.Results Data were collected on a total of 7870 critically ill neonates admitted to the MIMICⅢdatabase from 2001 to 2008.Of these children,1022 were neonates with sepsis and approximately(8.22%)neonates with sepsis-associated liver injury(SALI),84 in total.A log rank test of 28-day survival between patients in the neonatal SALI group and those in the no-SALI group showed a significant difference in 28-day survival between the two groups(χ^(2)=55.924,P<0.001),with a significantly higher morbidity and mortality rate in the SALI group than in the no-SALI group within 28 days.Univariate and multifactorial analysis of neonates who developed SALI assessed that birth weight,blood lactate and red blood cell distribution width(RDW)were independent risk factors for neonates with sepsis combined with liver injury,with birth weight OR 3.102(95%CI 1.865 to 6.214)P=0.0023 and blood lactate OR 4.684(95%CI 2.577 to 7.025)P=0.0016,and RDW OR 2.681(95%CI 1.408 to 6.420).ROC analysis consisting of a model of birth weight,blood lactate and red blood cell distribution width(RDW)and commonly used severity scores for critically ill patients showed a model AUC 0.834;SOFA score AUC 0.709 and SAPS2 score AUC 0.733,and the prediction model showed better prediction of risk of in-hospital death in SALI patients compared with SOFA and SAPS2 scores showed better discriminatory power.The ICU length of stay was significantly longer in the death group than in the survival group.Conclusion The occurrence of sepsis-associated liver injury(SALI)in neonates affects neonatal survival.Birth weight,blood lactate and red blood cell distribution width(RDW)are independent risk factors for neonates with sepsis-associated liver injury,which can help clinicians identify high-risk patients early and inform clinical treatment strategies.
作者
吴灿
刘念
WU Can;LIU Nian(The First Hospital of Anhui Medical University,Hefei 230022,China)
出处
《肝胆外科杂志》
2023年第4期277-280,313,共5页
Journal of Hepatobiliary Surgery
