摘要
目的 探讨降钙素原与白蛋白比值(procalcitonin-to-albumin ratio,PAR)对老年脓毒症患者28 d死亡风险的预测价值,为优化老年脓毒症的诊断与治疗策略提供科学依据。方法 回顾性分析112例重症监护病房诊断为脓毒症的老年患者临床资料。依据28 d生存情况将患者分为生存组和死亡组,收集其临床特征和实验室指标,包括降钙素原(PCT)、白蛋白(Alb)及C反应蛋白(CRP)。符合正态分布的两组间比较采用t检验;非正态分布资料组间比较采用Mann-Whitney U检验;采用Cox回归分析多个变量对生存时间的影响,受试者工作特征(ROC)曲线分析预测患者死亡的灵敏度和特异度。结果 死亡组与生存组在机械通气、APACHE Ⅱ评分及住院时间上差异存在统计学意义(P均<0.05)。血培养结果显示革兰阴性菌为主要病原菌(75.9%),其中大肠埃希菌占比最高(45.5%)。死亡组的Alb水平显著低于生存组(P=0.026),而PCT、CRP和PAR显著高于生存组(P<0.05)。多因素Cox回归分析显示PAR是28 d死亡的独立预测因子(HR=3.72,95% CI:1.98~4.42,P<0.001)。ROC曲线分析结果表明PAR预测死亡的曲线下面积(AUC)为0.852,灵敏度为81.25%,特异度为87.82%。结论 PAR在老年脓毒症患者28 d死亡风险预测中表现优于单独的PCT或Alb指标,PAR每增加0.1,患者死亡风险增加272%。通过早期监测PAR,可帮助临床快速识别高危患者并优化治疗决策。
Objective To investigate the value of procalcitonin-to-albumin ratio(PAR)for predicting 28-day mortality risk in elderly patients with sepsis for optimizing the diagnosis and treatment strategies.Methods The clinical data of 112 elderly patients diagnosed with sepsis in the intensive care unit were retrospectively reviewed and analyzed.Patients were assigned to survivors group or deaths group based on 28-day outcomes.Clinical characteristics and the results of laboratory tests were collected,including procalcitonin(PCT),albumin,and C-reactive protein(CRP).The normally distributed data were compared between groups using t-test.Mann-Whitney U test was adopted for comparing non-normally distributed data.Cox proportional hazards regression model was used to analyze the effects of multiple variables on survival time.Receiver operating characteristic(ROC)curve analysis was performed to determine the sensitivity and specificity of various variables in predicting mortality risk.Results Mechanical ventilation,APACHE II scores,and length of hospital stay(all P<0.05)were significantly different between survivors group and deaths group.Blood culture results showed that Gram-negative bacteria were predominant pathogen(75.9%),especially Escherichia coli(45.5%).Albumin level was significantly lower(P=0.026),while PCT,CRP,and PAR levels were significantly higher(P<0.05)in the deaths group compared to those in the survivors group.Multivariate Cox regression analysis revealed that PAR was an independent predictor of 28-day mortality(HR=3.72,95%CI:1.98-4.42,P<0.001).ROC curve analysis showed that the area under the curve(AUC)of PAR was 0.852 in predicting mortality,with a sensitivity of 81.25%and specificity of 87.82%.Conclusions PAR outperformed PCT or albumin alone in predicting 28-day mortality risk in elderly patient with sepsis.For every 0.1 increase in PAR,the risk of mortality increased by 272%.Early monitoring of PAR can assist clinicians in rapidly identifying high-risk patients and optimizing treatment strategies.
作者
王娜
刘波
王加平
胡明
孙召东
黄廷廷
吴惠毅
孙润峰
WANG Na;LIU Bo;WANG Jiaping;HU Ming;SUN Zhaodong;HUANG Tingting;WU Huiyi;SUN Runfeng(Department of Clinical Laboratory,Donghai People’s Hospital Affiliated to Kangda College of Nanjing Medical University,Lianyungang Jiangsu 223000,China)
出处
《中国感染与化疗杂志》
北大核心
2025年第5期511-516,共6页
Chinese Journal of Infection and Chemotherapy
基金
连云港市社会发展项目重点研发计划资助(SF2350)。
作者简介
第一作者:王娜(1979-),女,学士,主任技师,主要从事临床免疫学检验专业。;通信作者:王加平,E-mail:13585281988@163.com。
