降钙素原、D-二聚体联合SOFA评分对脓毒症预后的评估价值

目的:探讨降钙素原（PCT）、D-二聚体（D-dimer，D-D）联合序贯器官衰竭估计评分（SOFA评分）对脓毒症患者预后的评估价值。方法:回顾性分析2018年10月—2020年5月在重症监护病房（ICU）治疗的100例脓毒症患者的相关临床数据，按28 d预后将患者分为生存组和死亡组，比较两组PCT、D-D、SOFA评分差异，通过Logistic回归分析确认影响脓毒症患者预后的独立危险因素，建立PCT、D-D和SOFA评分的组合，绘制受试者工作特征（ROC）曲线，分析PCT、D-D联合SOFA评分对脓毒症患者预后的评估价值。结果:（1）死亡组的PCT（Z=-5.473，P<0.05）、D-D（Z=-4.454，P<0.05）和SOFA评分（Z=-4.859，P<0.05）均明显高于生存组，差异有统计学意义。（2）Logistic回归分析显示PCT（OR=1.284，95%CI:1.099～1.500）、D-D（OR=1.552，95%CI:1.130～2.131）及SOFA评分（OR=1.458，95%CI:1.157～1.837）是影响脓毒症患者预后的独立危险因素（均P<0.05）。（3）PCT、D-D联合SOFA评分评估脓毒症28 d预后的曲线下面积（AUC）0.957大于单独使用PCT、D-D和SOFA评分的面积（0.883、0.811、0.838），且PCT、D-D联合SOFA评分的灵敏度及特异度分别为90.9%和84.6%，也较单独指标有所提高。结论:PCT、D-D和SOFA评分是影响脓毒症患者预后的独立危险因素；PCT、D-D联合SOFA评分评估脓毒症患者预后的能力大于单一指标。

Prognostic value of procalcitonin and D-dimer combined with SOFA scores in sepsis

Objective: To evaluate the prognostic value of procalcitonin（PCT） and D-dimer（D-D） combined with sequential organ failure assessment（SOFA） scores in patients with sepsis. Methods: The clinical data of 100 patients with sepsis who were treated in the ICU during the period of October 2018 to May 2020 were retrospectively analyzed. The patients were divided into survival group and death group according to the prognosis of 28 d. The differences of PCT，D-D and SOFA scores between the two groups were compared，the independent risk factors affecting prognosis of patients with sepsis were confirmed by Logistic regression analysis，the combination of PCT，D-D and SOFA score was established，and the receiver operating characteristic（ROC） curve was drawn.The prognostic value of PCT，D-D combined with SOFA score in patients with sepsis was analyzed. Results:（1）The PCT（Z=-5.473，P<0.05），D-D（Z=-4.454，P<0.05） and SFOA scores（Z=-4.859，P<0.05） in death group were significantly higher than that in survival group，the difference was statistically significant. （2）Logistic regression analysis showed that PCT（OR=1.284，95%CI: 1.099-1.500），D-D（OR=1.552，95%CI:1.130-2.131） and SOFA scores （OR=1.458，95%CI:1.157-1.837） were independent risk factors for prognosis of patients with sepsis（all P<0.05）.（3）The area under the curve（AUC） of the 28 d prognosis of sepsis assessed by PCT，D-D combined with SOFA scores（0.957） was larger than that of AUC（0.883，0.811，0.838） using PCT，D-D and SOFA scores alone. The sensitivity and specificity of PCT，D-D combined with SOFA scores were 90.9% and 84.6% respectively，which were higher than those individual indicators. Conclusion: PCT，D-D and SOFA scores are independent risk factors for prognosis of patients with sepsis，and PCT，D-D combined SOFA scores is more effective than single index in evaluating prognosis of patients with sepsis.