老年脓毒症患者临床特征及预后影响因素

 目的 探讨老年脓毒症患者临床特征及影响预后的危险因素。方法 选取2020年7月-2021年9月某三级甲等医院收治的老年脓毒症患者为研究对象,记录患者的临床及实验室资料,根据患者28天预后情况分为存活组和死亡组,比较各临床指标在两组间的差异,应用二元logistic回归分析法分析影响老年脓毒症患者预后的独立危险因素,进一步绘制受试者工作特征（ROC）曲线,评估不同指标预测患者预后的价值。结果 共纳入121例患者,其中74例为脓毒症,47例为脓毒性休克。存活组92例,死亡组29例。与存活组相比,死亡组患者发生脓毒性休克、合并症个数 ≥ 2的比例均较高（P<0.05）;序贯器官衰竭评估（SOFA）评分和急性生理与慢性健康状况评估（APACHEⅡ）评分也较高,白细胞介素6（IL-6）、胱抑素C（Cys-C）、降钙素原（PCT）、凝血酶原时间（PT）和D -二聚体（D -D）表达水平均增高（均P<0.05）,而淋巴细胞绝对计数（ALC）和清蛋白（ALB）表达水平降低（均P<0.01）。二元logistic回归分析显示脓毒性休克、SOFA评分、D -D及Cys-C表达水平是影响老年脓毒症患者28天预后的独立危险因素。ROC曲线分析显示SOFA评分（AUC=0.758）、D -D（AUC=0.774）、Cys-C（AUC=0.650）预测患者的预后均有一定的价值（均P<0.01）,与单个指标相比,三个指标的联合检测显示出更高的预测价值（AUC=0.882）。结论 发生脓毒性休克、SOFA评分增高、D -D及Cys-C表达水平增加是导致老年脓毒症患者病死率上升的独立危险因素,SOFA评分、D -D和Cys-C的联合检测可进一步提高脓毒症患者预后的预测价值,为临床治疗和预后评估提供参考依据。

Clinical characteristics and prognostic factors of elderly patients with sepsis

Objective To explore the clinical characteristics and prognostic risk factors for elderly patients with sepsis. Methods The elderly patients with sepsis treated in a tertiary first-class hospital from July 2020 to September 2021 were selected, clinical and laboratory data of patients were recorded, patients were divided into survival group and death group according to 28-day prognosis, differences in clinical indicators between two groups were compared, independent risk factors for prognosis of elderly patients with sepsis were analyzed by binary logistic regression analysis, receiver operating characteristic curve(ROC) was drawn to evaluate the effect of different indicators on predicting the prognosis of patients. Results A total of 121 patients were included in analysis, including 74 cases of sepsis and 47 cases of septic shock. 92 patients were in survival group and 29 in death group. Compared with the survival group, the proportion of septic shock and the number of complications ≥ 2 in death group was higher (P<0.05); the scores of sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation (APACHE Ⅱ) were higher, the expression levels of interleukin 6(IL-6), cystatin C (Cys-C), procalcitonin (PCT), prothrombin time (PT), and D-dimer (D -D) all enhanced (all P<0.05), while expression level of absolute lymphocyte count (ALC) and expression of albumin (ALB) dropped (both P<0.01). Binary logistic regression analysis showed that septic shock, SOFA score, D -D and expression of Cys-C were independent risk factors affecting the 28-day prognosis of elderly patients with sepsis. ROC curve analysis showed that SOFA score (AUC=0.758), D -D (AUC=0.774) and Cys-C (AUC=0.650) had a certain value for the prediction of prognosis of patients (all P<0.01), compared with a single indicator, the combined detection of three indicators showed a higher predictive value (AUC=0.882). Conclusion Occurrence of septic shock, increase of SOFA score as well as enhanced expression of D -D and Cys-C are independent risk factors leading to the increase of mortality in elderly patients with sepsis. The combined detection of SOFA score, D -D and Cys-C can further improve the predictive value of prognosis in patients with sepsis, and provide reference basis for clinical treatment and prognosis evaluation.