肝硬化伴全身炎症反应综合征患者预后影响因素的Logistic回归分析

目的 探讨肝硬化伴全身炎症反应综合征(SIRS)患者预后的影响因素.方法 对136例肝硬化伴SIRS患者进行回顾性分析,根据患者病情转归分为死亡组(52例)与存活组(84例),比较两组患者临床资料,应用Logistic回归分析筛选肝硬化伴SIRS死亡相关的独立危险因素.结果 单因素分析结果显示,死亡组的白蛋白、胆碱酯酶水平分别为(27.68±4.84)g/L和(2647.12±1 057.18)U/L,均低于存活组(t=0.007,P＜0.01;t=0.017,P＜0.05);死亡组血肌酐(Cr)、空腹血糖水平、白细胞总数、C反应蛋白(CRP)和降钙素原(PCT)水平的中位数分别为175.40 μmol/L、5.43 mmol/L、8.10×109/L、24.00 mg/L和1.20 μg/L,均高于存活组(Z=0.000、0.000、0.009、0.012和0.013,P均＜0.05);此外,死亡组的中性粒细性百分比、肝性脑病发生率、消化道出血发生率、Child-pugh C级比例、败血症发生率、肺部感染发生率和多部位感染发生率分别为(76.73±14.02)％、28.85％、34.62％、44.23％、34.62％、73.08％和90.38％,均高于存活组,差异均有统计学意义(t=0.009、x2=28.950、42.810、18.260、16.680、41.177和78.440,P均＜0.05).成组Logistic逐步回归筛选结果有意义的因素为:Cr＞165 μmol/L (OR=6.590,95％CI:1.907～22.778)、消化道出血(OR=29.207,95％CI:4.506～189.290)、CRP＞25 mg/L (OR=9.757,95％CI:1.732～54.969)、PCT＞1 μg/L(OR=20.350,95％CI:2.617～158.264)和多部位感染(OR=30.760,95％CI:2.934～322.572).结论 Cr＞165 μmol/L、消化道出血、CRP＞25 mg/L、PCT＞1 μg/L和多部位感染是肝硬化伴SIRS患者死亡的独立危险因素.

Logistic regression analysis on prognostic influence factors of liver cirrhosis patients with systemic inflammatory response syndrome

Objective To investigate the prognostic influence factors of liver cirrhosis patients with systemic inflammatory response syndrome (SIRS).Methods A total of 136 liver cirrhosis patients with SIRS were analyzed retrospectively,and were divided into death group (n=52) and survival group(n=84) by the outcome of the disease.The clinical data in 2 groups were compared.The independent risk factors of death in liver cirrhosis patients with SIRS were analyzed by Logistic regression.Results The result of single-factor analysis revealed that the levels of albumin (ALB) and cholinesterase (CHE) in death group were (27.68±-4.84) g/L and (2 647.12±1 057.18) U/L,and were both lower than those in survival group (t=0.007,P＜0.0 1;t=0.0 17,P＜0.05).The levels of serum creatinine (Cr),fasting blood-glucose (FBS),total white blood cell count,serum CRP and PCT in death group were 175.40 μmol/L,5.43 mmol/L,8.10×109/L,24.00 mg/L and 1.20 μg/L,and were higher than those in survival group (Z=0.000,0.000,0.009,0.012 and 0.013,Pall ＜0.05).In addition,the neutrophil proportion,incidence rates of hepatic encephalopathy,gastrointestinal hemorrhage,Child-pugh C grade,sepsis,pulmonary infection and multiple sites of infection in death group were (76.73±14.02)％,28.85％,34.62％,44.23％,34.62％,73.08％ and 90.38％,and were higher than those in survival group (t=0.009,x2=28.950,42.81 0,18.260,16.680,41.177 and 78.440,Pall ＜0.05).Logistic regression stepwise screening results showed that Cr＞165 μmol/L (OR=6.590,95％CI:1.907-22.778),gastrointestinal hemorrhage (OR=29.207,95％CI.4.506-189.290),CRP＞25 mg/L (OR=9.757,95％CI:1.732-54.969),PCT＞1 μg/L (OR=20.350,95％CI:2.617-158.264) and multi-site infection (OR =30.760,95％ CI:2.934-322.572) were significant factors.Conclusions Cr＞165 μmol/L,gastrointestinal hemorrhage,CRP＞25 mg/L,PCT＞ μg/L and multi-site infection are regarded as independent risk factors of mortality for liver cirrhosis patients with SIRS.