重症脓毒症患者血清胆红素水平与ARDS发生率和死亡率的相关性研究

目的：探讨重症脓毒症患者血清胆红素水平与ARDS发生率和死亡率的相关性。方法：连续性收录我院2013年1月至2014年6月收治的脓毒症患者86例。所有入选患者记录APACHE II评分,血常规,常规生化检验,胆红素水平,记录患者住院期间的预后情况。利用受试者工作特征曲线(receiver operator characteristic analysis, ROC analysis)综合分析胆红素水平对脓毒症并发ARDS患者的诊断价值。应用Logistic回归分析胆红素与脓毒症并发ARDS的危险度。结果： ARDS组中,死亡患者入科时总胆红素,直接胆红素以及间接胆红素水平(36.1±22.5 umol/L,10.9±11.2 umol/L,28.8±14.2umol/L)均高于存活患者(26.6±15.1 umol/L,8.9±5.2 umol/L,18.4±7.2 umol/L)(P总胆红素<0.05),死亡患者在诊断ARDS当天血清总胆红素明显高于存活组(46.8±18.3umol/L vs. 33.8±19.2 umol/L)(P<0.05)。诊断ARDS当天的总胆红素水平对于ARDS的诊断有中等程度的诊断价值(AUC=0.689,P=0.013)。在入ICU时,血清总胆红素水平每升高1mg/dL,ARDS发生风险增加51%(OR=1.51,P=0.031),死亡风险增加68%(OR= 1.68,P=0.012)。诊断ARDS时,血清总胆红素水平每升高1mg/dl,死亡风险增加167%(OR=2.67,P=0.008)。 结论：脓毒症患者中,胆红素水平与ARDS的发生以及病情预后密切相关。

The relation study between serum bilirubin and ARDS development and mortality in sepsis patients1Jiang Bo 2Jiang Zhiyong 1Xu Zhaozhen

Objective: To evaluate the relation between serum bilirubin and ARDS development and mortality in sepsis patients. Methods: Eighty-six sepsis patients were enrolled and randomlly divided into two group: sepsis group(n=32) and ARDS development group(n=54). APACHE II scores, blood routine test, biochemical detection, serum bilirubin and clinical prognosis were recorded. Receiver operator characteristic (ROC) analysis was used to evaluate the the bilirubin diagnosis value of the ARDS development in sepsis patients. Logistic regression analysis was used to test risk factor of bilirubin on the development of ARDS on sepsis patients. Results:In the group of ARDS development, the ICU admission levels of total bilirubin, direct bilirubin and indirect bilirubin in death were higher than those in survivors(36.1±22.5 umol/L, 10.9±11.2 umol/L, 28.8±14.2umol/L vs. 26.6±15.1 umol/L, 8.9±5.2 umol/L, 18.4±7.2 umol/L, PTB<0.05). The levels of total bilirubin on ARDS diagosis day showed a moderate diagnosis value of ARDS development in sepsis patients(AUC=0.689,P=0.013). Compared with normal levels of total bilirubin, patients with hyperbilirubinemia had higher risks of ARDS development (OR=1.51,P=0.031) and mortality(OR=2.67,P=0.008). Conclusion: In sepsis patients, higher serum bilirubin level is associated with subsequent ARDS development and mortality.