联合生物电阻抗评估危重症患者预后

目的:分析生物电阻抗参数在危重评分变化与预后的关系.方法:筛选2018年6月至2019年6月入住东部战区总医院重症监护室(ICU)第1天及第3天两次行多频生物电阻抗(BIA)测量的患者,记录其电阻抗值(Z)、电流频率(f)、回归系数S值及临床数据,包括简化急性生理学评分Ⅱ(SAPSⅡ)、序贯器官衰竭评估(SOFA)及急性生理学和慢性健康评估Ⅱ(APACHEⅡ)评分.根据S值及危重评分预测90d死亡能力绘制受试者工作特征曲线的截断值定义病情轻重;根据第3天危重评分较基线变化绝对值的25百分位数定义病情好转及恶化;而第3天S值则仍采用病情轻重判断标准.分别以危重评分及S值为依据,将患者分为轻症无恶化组、轻症恶化组、重症好转组、重症无好转组.以90d为终点,分析以上参数与预后关系.结果:共入选113例患者,其中男性83例,90d死亡率35.4%.生存及死亡者S值、危重评分存在显著差异.依据各项指标分组患者Kaplan-Meier生存曲线显示以S值及SAPSⅡ为分组依据的各组生存率差异最明显.联合S值及SAPSⅡ对患者进行赋分,显示死亡率与分值显著线性相关(预测公式为Y=0.174X,R20.96,P<0.001).COX回归分析显示仅S-SAPSⅡ联合分值为90d死亡独立危险因素(HR=2.00,95%CI 1.53~2.61,P<0.001).结论:S值、SAPSⅡ评分动态变化可更好区分预后不同的患者,而两者动态变化的联合评分则进一步显示了与危重症患者死亡率很强线性相关,提示联合评分在判断病情严重程度上的价值.

Combination of dynamic disease severity scores and bioelectrical impedance analysis in critically ill patients

Objective:To implore the relationship between dynamic disease severity scores,bioelectrical impedance analysis(BIA) and the outcomes of critically ill patients. Methodology:Patients admitted to the intensive care unit in Jinling Hospital from June 2018 to June 2019 were screened,which had the record of 2 times of BIA measurement on the first and the third day of ICU stay was enrolled. Data from BIA including electrical impedance value(Z),current frequency(f),and the regression coefficient S value between Z and f,were collected,as well as clinical data including simplified acute physiology score Ⅱ(SAPS Ⅱ),sequential organ failure assessment(SOFA),and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ). The cutoff values of the receiver operating characteristic(ROC) curve for the S value and disease severity scores to predict the 90-day death were used to define the 1st day disease severity as mild and severe. The 25th percentile value of the 3rd day disease severity scores deviation from the baseline was used to define the disease at the 3rd day as improved or deteriorated,while for S value,the definition of improved or deteriorated at the 3rd day was still using the cutoff value of ROC at the 3rd day. Basing on the 1st condition(mild or severe)and the 3rd day change(improved or deteriorated),the patients were divided into 4 groups: mild,non-deteriorated;mild,deteriorated;severe,improved;severe,non-improved. The endpoint was the 90-day follow-up,then the relationship between the above-mentioned parameters and the outcomes was analyzed. Results:Among 113 patients enrolled,83 were man,and the 90-day mortality rate was 35.4%. Between the dead and survived patients,significant differences were found for S value and all disease severity scores(P<0.05). The difference of Kaplan-Meier survival curves between 4 groups divided according to different parameters was significant only for S value and SAPS Ⅱ score(P<0.05). A new score combining S value and SASP Ⅱ showed a good linear correlation with survival rate(prediction equation: Y=0.174 X,R2 0.96,P<0.001). COX regression analysis showed that the S-SAPS Ⅱ score are the only independent risk factor for 90-day death(HR=2.00,95%CI 1.53-2.61,P<0.001). Conclusion:The dynamic changes of S value,SAPS Ⅱ score are better to discriminate patients with different outcomes,a new score combining both of them shows a good linear correlation with survival rate,which may imply its value in disease severity assessment.