血清冷诱导RNA结合蛋白与脓毒性休克患者病情严重程度及预后的相关性

目的探讨血清冷诱导RNA结合蛋白(CIRP)与脓毒性休克患者病情严重程度及预后的相关性。方法回顾性选取2018年1月至2020年1月海南医学院第二附属医院急诊重症监护室(EICU)收治的脓毒性休克患者107例为研究对象。收集患者一般资料、急性生理和慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分、CIRP、血乳酸(Lac)、血清肌酐(s Cr)、血白细胞计数(WBC)、中性粒细胞百分比(NeuR)及降钙素原(PCT)。根据患者28 d预后情况将其分为死亡组和存活组。采用Pearson相关分析探讨脓毒性休克患者CIRP与SOFA评分及APACHEⅡ评分的相关性;采用Logistic回归分析探讨脓毒性休克患者28 d死亡的危险因素;绘制受试者工作特征(ROC)曲线并评估各指标对脓毒性休克患者28 d死亡的预测价值。结果随访28 d后,25例(23.4%)患者死亡(死亡组),82例(76.6%)患者存活(存活组)。死亡组APACHEⅡ评分、SOFA评分、CIRP、血Lac、s Cr及PCT水平明显高于存活组(P <0.05)。Pearson相关分析结果显示,脓毒性休克患者CIRP与SOFA评分及APACHEⅡ评分均呈正相关(r=0.337,P=0.005;r=0.249,P=0.039)。多因素Logistic回归分析结果显示,APACHEⅡ评分OR=1.138,95%CI(1.066,1.214)]、SOFA评分OR=1.326,95%CI(1.174,1.478)]、CIRPOR=1.322,95%CI(1.141,1.502)]及PCTOR=1.055,95%CI(1.003,1.108)]为脓毒性休克患者28 d死亡的危险因素(P <0.05)。CIRP、SOFA评分、APACHEⅡ评分、PCT预测脓毒性休克患者28 d死亡的ROC曲线下面积(AUC)分别为0.91595%CI(0.823,0.969)]、0.83495%CI(0.726,0.913)]、0.79895%CI(0.684,0.885)]、0.68595%CI(0.562,0.792)]。CIRP预测脓毒性休克患者28 d死亡的AUC大于SOFA评分、APACHEⅡ评分、PCT预测脓毒性休克患者28 d死亡的AUC(Z=2.134,P=0.041;Z=2.348,P=0.026;Z=3.64,P <0.001)。CIRP的最佳临界值为2.6μg/L时,预测脓毒性休克患者28 d死亡的敏感度为96.8%,特异度为73.7%。结论血清CIRP与脓毒性休克患者病情严重程度及预后密切相关,为28 d死亡的独立危险因素,可作为评价脓毒性休克患者预后的较好指标。

Correlation of serum cold-inducible RNA-binding protein level with the illness severity and prognosis in the patients with septic shock

Objective To explore the correlation of serum cold-inducible RNA-binding protein( CIRP) level with the illness severity and prognosis in the patients with septic shock. Methods A total of 107 patients with septic shock admitted to the Emergency Intensive Care Unit( EICU) of the Second Affiliated Hospital of Hainan Medical College from January 2018 to January 2020 were retrospectively selected as the research objects. General data,acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) score,sepsis-related organ failure assessment( SOFA) score,CIRP,lactate( Lac), serum creatinine( s Cr), white blood cell count( WBC), neutrophil ratio( NeuR) and procalcitonin( PCT) were collected. The patients were divided into the survival group and death group according to 28-day prognosis. The correlations of the CIRP level with the APACHEⅡ score and the SOFA score in the patients with septic shock were explored by Pearson correlation analysis. The risk factors for 28-day mortality in the patients with septic shock were explored by Logistic regression analysis. And the receiver operating characteristic( ROC) curves were drawn to evaluate the value of each index for predicting 28-day mortality in the patients with septic shock. Results After 28 days of follow-up,25 cases( 23. 4%) died( death group),and 82 cases( 76. 6%) patients survived( survival group). The level of APACHEⅡ score,SOFA score,CIRP,Lac,s Cr and PCT in the death group were higher than those in survival group( P < 0. 05). Pearson correlation analysis showed that the levels of CIRP were positively correlated with both SOFA score( r = 0. 337,P = 0. 005) and APACHEⅡ score( r =0. 249,P = 0. 039). Multivariate Logistic regression analysis showed that APACHE Ⅱ scoreOR =1. 138,95% CI( 1. 066,1. 214) ],SOFA scoreOR = 1. 326,95% CI( 1. 174,1. 478) ],CIRPOR =1. 322,95% CI( 1. 141,1. 502) ]and PCTOR = 1. 055,95% CI( 1. 003,1. 108) ]were independent risk factors for 28-day mortality in the patients with septic shock( P < 0. 05). The area under ROC curve( AUC) of CIRP,SOFA score,APACHEⅡ score and PCT for predicting 28-day mortality in the patients with septic shock were 0. 91595% CI( 0. 823,0. 969) ],0. 83495% CI( 0. 726,0. 913) ],0. 79895% CI( 0. 684,0. 885) ]and 0. 68595% CI( 0. 562,0. 792) ],respectively. The AUC of CIRP for predicting 28-day mortality in the patients with septic shock was significantly larger than that of SOFA score,APACHEⅡ score and PCT alone( Z = 2. 134,P = 0. 041;Z = 2. 348,P = 0. 026;Z = 3. 64,P < 0. 001). The optimal cutoff value of the CIRP level was 2. 6 μg/L,which displayed a sensitivity of96. 8% and a specificity of 73. 7% for the prediction of 28-day mortality in the patients with septic shock. Conclusion The level of serum CIRP was closely related to the illness severity and prognosis in the patients with septic shock,and it was independent risk factor for 28-day mortality. CIRP can be a better indicator for evaluating the prognosis in the patients with septic shock.