血清磷对脓毒症生存状况影响的动态观察研究
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摘要
目的:探讨血清磷浓度动态变化对脓毒症患者生存状况的预测价值。方法:回顾性分析2017年1月至2017年12月于我院进行治疗的92例脓毒症患者的临床资料,根据28 d生存状况将患者分为生存组(63例)与死亡组(29例),死亡率31.52%。收集并比较2组患者的临床资料、APACHEⅡ评分、入重症医学科(intensive care unit,ICU)后第1、3、5、7天血清磷水平,采用受试者工作特征曲线(ROC)评估不同时间血清磷水平、APACHEⅡ评分对脓毒症患者生存状况的预测价值。结果:2组脓毒症患者之间的有创机械通气比例、感染部位分布、入住ICU时间差异无统计学意义(P>0.05);生存组脓毒症患者血管活性药物使用率及APACHEⅡ评分均明显低于死亡组(P<0.05)。2组脓毒症患者入住ICU第1天血清磷水平差异无统计学意义(P>0.05);生存组脓毒症患者的血清磷水平呈逐渐升高的趋势,死亡组脓毒症患者的血清磷水平呈逐渐降低的趋势;生存组毒症患者入住ICU第3、5、7天血清磷水平明显高于死亡组(P<0.05)。其中入住ICU第7天血清磷水平、APACHEⅡ评分AUC分别为0.952和0.830,95%CI为0.912～0.996和0.742～0.915,预测价值较高;而入住ICU第7天血清磷水平截断值为1.02 mmol/L,其对于脓毒症患者生存状况的敏感度与特异度均较高,为92.31%和82.61%,阳性似然比5.31,阴性似然比0.09。结论:生存组脓毒症患者的血清磷水平呈逐渐升高的趋势,而死亡组脓毒症患者的血清磷水平则呈逐渐降低的趋势;入住ICU第7天血清磷水平对于脓毒症患者的生存状况的敏感度与特异度最高,预测价值最大。
Objective:To investigate the value of dynamic changes of serum phosphorus concentration in predicting the survival of patients with sepsis. Methods:A retrospective analysis was performed for the clinical data of 92 patients with sepsis who were treated in our hospital from January to December,2017. According to the 28-day survival,the patients were divided into survival group with 63 patients and death group with 29 patients,and the mortality rate was 31.52%. The two groups were compared in terms of clinical data,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score,and serum phosphorus levels on days 1,3,5,and 7 after admission to the intensive care unit(ICU),and the receiver operating characteristic(ROC)curve was used to evaluate the value of serum phosphorus at different time points and APACHEⅡ score in predicting the survival of patients with sepsis. Results:There were no significant differences in the proportion of patients undergoing invasive mechanical ventilation,the distribution of infection sites,and the duration of ICU stay between the two groups(P>0.05),and the survival group had significantly lower rate of use of vasoactive drugs and APACHE Ⅱ score than the death group(P<0.05). There was no significant difference in serum phosphorus between the two groups on day 1 after admission to the ICU(P>0.05);the survival group had a gradual increase in serum phosphorus,while the death group had a gradual reduction;on days 3,5,and 7 after admission to the ICU,the survival group had a significantly higher serum phosphorus level than the death group(P<0.05). Serum phosphorus level on day 7 after admission to the ICU and APACHEⅡ score had an area under the ROC curve of 0.952(95% confidence interval[CI]:0.912-0.996)and 0.830(95% CI:0.742-0.915),respectively,and thus had a high predictive value. At the cut-off value of1.02 mmol/L,serum phosphorus level on day 7 after admission to the ICU had a sensitivity of 92.31%,a specificity of 82.61%,a positive likelihood ratio of 5.31,and a negative likelihood ratio of 0.09 in predicting the survival of patients with sepsis. Conclusion:The survival group has a gradual increase in serum phosphorus,while the death group has a gradual reduction. Serum phosphorus level on day 7 after admission to the ICU has the highest sensitivity and specificity in predicting the survival of patients with sepsis and thus has the highest predictive value.
Objective:To investigate the value of dynamic changes of serum phosphorus concentration in predicting the survival of patients with sepsis. Methods:A retrospective analysis was performed for the clinical data of 92 patients with sepsis who were treated in our hospital from January to December,2017. According to the 28-day survival,the patients were divided into survival group with 63 patients and death group with 29 patients,and the mortality rate was 31.52%. The two groups were compared in terms of clinical data,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score,and serum phosphorus levels on days 1,3,5,and 7 after admission to the intensive care unit(ICU),and the receiver operating characteristic(ROC)curve was used to evaluate the value of serum phosphorus at different time points and APACHEⅡ score in predicting the survival of patients with sepsis. Results:There were no significant differences in the proportion of patients undergoing invasive mechanical ventilation,the distribution of infection sites,and the duration of ICU stay between the two groups(P>0.05),and the survival group had significantly lower rate of use of vasoactive drugs and APACHE Ⅱ score than the death group(P<0.05). There was no significant difference in serum phosphorus between the two groups on day 1 after admission to the ICU(P>0.05);the survival group had a gradual increase in serum phosphorus,while the death group had a gradual reduction;on days 3,5,and 7 after admission to the ICU,the survival group had a significantly higher serum phosphorus level than the death group(P<0.05). Serum phosphorus level on day 7 after admission to the ICU and APACHEⅡ score had an area under the ROC curve of 0.952(95% confidence interval[CI]:0.912-0.996)and 0.830(95% CI:0.742-0.915),respectively,and thus had a high predictive value. At the cut-off value of1.02 mmol/L,serum phosphorus level on day 7 after admission to the ICU had a sensitivity of 92.31%,a specificity of 82.61%,a positive likelihood ratio of 5.31,and a negative likelihood ratio of 0.09 in predicting the survival of patients with sepsis. Conclusion:The survival group has a gradual increase in serum phosphorus,while the death group has a gradual reduction. Serum phosphorus level on day 7 after admission to the ICU has the highest sensitivity and specificity in predicting the survival of patients with sepsis and thus has the highest predictive value.
引文
[1]杨巧云,周仪,俞建峰,等.动态血清磷水平对脓毒症患者预后的预测价值[J].中华危重病急救医学,2017,29(12):1077-1081.
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[7]何青莲,张凌,程小云,等.降钙素原在慢性肾脏病合并脓毒血症患者中的应用[J].西部医学,2016,28(9):1218-1220,1226.
[8]钱阳晶,杨定平.高容量血液滤过治疗脓毒症合并急性肾损伤疗效分析[J].临床肾脏病杂志,2016,16(6):360-364.
[9]张建群.低磷血症在危重症患者中的临床意义及研究进展[J].中国现代药物应用,2014,8(12):240-242.
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[11]陶晓根,赵劲松,王锦权,等.脓毒症患者血磷浓度变化对疾病预后的影响[J].中国临床保健杂志,2008,11(4):371-373.
[12]王武超,薛晓艳,刘昳冉,等.早期血磷情况与脓毒症患者预后的相关性[J].中国急救医学,2012,32(11):984-988.
[13]付素珍,马骏,孙杰,等.血必净注射液联合血液净化治疗对脓毒血症疗效及免疫调节影响[J].环球中医药,2013,11(6):93.
[14]Shor R,Halabe A,Rishver S,et aL.Severe hypophosphatemia in sepsis as a mortality predictor[J].Ann Clin lab Sci,2006,36(1):67-72.
[15]于革新.不同血液净化方式对尿毒症患者血磷的清除作用及其影响因素[J].航空航天医学杂志,2016,27(6):684-686.
[16]Fischer CM,Yano K,Aird WC,et al.Abnormal coagulation tests obtained in the emergency department are associated with mortality in patients with suspected infection[J].J Emerg Med,2012,42(2):127-132.
[2]许春奇,尚亚东,程仁力,等.环磷腺苷葡胺联合地高辛治疗脓毒症致心肌顿抑性心力衰竭的疗效分析[J].中国全科医学,2017,20(17):2131-2134.
[3]张晓丽,曲彦,黄建波.不同致病菌所致脓毒症患者低磷血症的临床研究[J].中华急诊医学杂志,2014,23(5):558-561.
[4]傅冠华,张丽英,徐瑞龙,等.血清磷和hs-CRP联检对细菌性脓毒症早期诊断的临床价值[J].放射免疫学杂志,2013,26(3):379-380.
[5]Dellinger RP,Levy MM,Rhodes A,et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012[J].Crit Care Med,2013,41(2):580-637.
[6]吴广平,张敏州,孔祥照.从“五脏相关学说”探讨脓毒症心功能不全的辨治思路[J].环球中医药,2013,12(6):276-277.
[7]何青莲,张凌,程小云,等.降钙素原在慢性肾脏病合并脓毒血症患者中的应用[J].西部医学,2016,28(9):1218-1220,1226.
[8]钱阳晶,杨定平.高容量血液滤过治疗脓毒症合并急性肾损伤疗效分析[J].临床肾脏病杂志,2016,16(6):360-364.
[9]张建群.低磷血症在危重症患者中的临床意义及研究进展[J].中国现代药物应用,2014,8(12):240-242.
[10]Abraham E.New definitions for sepsis and septic shock:continuing evolution but with much still to be done[J].JAMA,2016,315(8):757-759.
[11]陶晓根,赵劲松,王锦权,等.脓毒症患者血磷浓度变化对疾病预后的影响[J].中国临床保健杂志,2008,11(4):371-373.
[12]王武超,薛晓艳,刘昳冉,等.早期血磷情况与脓毒症患者预后的相关性[J].中国急救医学,2012,32(11):984-988.
[13]付素珍,马骏,孙杰,等.血必净注射液联合血液净化治疗对脓毒血症疗效及免疫调节影响[J].环球中医药,2013,11(6):93.
[14]Shor R,Halabe A,Rishver S,et aL.Severe hypophosphatemia in sepsis as a mortality predictor[J].Ann Clin lab Sci,2006,36(1):67-72.
[15]于革新.不同血液净化方式对尿毒症患者血磷的清除作用及其影响因素[J].航空航天医学杂志,2016,27(6):684-686.
[16]Fischer CM,Yano K,Aird WC,et al.Abnormal coagulation tests obtained in the emergency department are associated with mortality in patients with suspected infection[J].J Emerg Med,2012,42(2):127-132.