Clinical value of SOFA combined with procalcitonin test in assessing the condition and prognosis of patients with sepsis
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摘要:
目的 动态观察序贯器官功能衰竭(sequential organ failure assessment，SOFA)评分、血清降钙素原(procalcitonin，PCT)在脓毒症患者中的变化，分析两者联合检测对脓毒症患者病情及预后的评估。 方法 选取2016年12月—2019年12月浙江大学医学院附属杭州市第一人民医院重症医学科收治的脓毒症患者40例，据病情严重程度及中国脓毒症/脓毒性休克急诊治疗指南(2018)将患者分为脓毒症组、脓毒性休克组，根据入院28 d是否存活分为存活组和死亡组，比较各组SOFA及PCT的变化，用受试者工作特征曲线(ROC曲线)下面积分析SOFA联合PCT对脓毒症患者病情及预后的预测价值。 结果 脓毒症组患者第1、5天SOFA评分与脓毒性休克组比较差异有统计学意义(均P < 0.01)；经过治疗脓毒症组SOFA评分改善更明显，PCT下降更明显。存活组患者第5天SOFA为(8.36±1.87)分，死亡组第5天SOFA为(13.22±2.84)分，两者比较差异有统计学意义(P < 0.01)；存活患者第5天PCT与死亡组比较差异有统计学意义(P < 0.01)。据ROC曲线分析，SOFA及PCT的曲线下面积(AUC)分别为0.607、0.814；SOFA及PCT联合的AUC为0.875。 结论 SOFA和PCT联合检测对脓毒症患者的病情及预后有预测意义。 -
关键词:
- 序贯器官功能衰竭评分 /
- 血清降钙素原 /
- 脓毒症
Abstract:Objective To observe the dynamic changes in sequential organ failure assessment (SOFA) scores and serum procalcitonin (PCT) in patients with sepsis and analyse the condition and prognosis of the patients through the combined assessment of the two tests. Methods Forty patients with sepsis who were admitted in the intensive care unit of Hangzhou City First People's Hospital affiliated to Zhejiang University School of Medicine from December 2016 to December 2019 were included in this study. The patients were divided into sepsis and septic shock groups according to the severity of their illness and following the 2018 China sepsis/septic shock emergency treatment guidelines (2018). The patients were further divided into survival and death groups; the patients in the survival group were those that remained alive within 28 days of admission. SOFA scores and changes in PCT were compared by analysing area under the receiver-operating characteristic (ROC) curve. The predictive value of these scores and changes was used to assess the condition and prognosis of the patients. Results On the first and fifth days, differences in SOFA scores between the sepsis group and the septic shock group were statistically significant (all P < 0.01). After the sepsis group was treated, the SOFA scores substantially improved, whereas PCT considerably decreased. On the fifth day, the SOFA score of the survival group (8.36±1.87) was lower than that of the death group (13.22±2.84), and the difference was statistically significant (P < 0.01). Moreover, the PCT of the survival group was significantly different from that of the death group (P < 0.01). ROC curve analysis revealed that the AUC of SOFA scores and PCT was 0.607 and 0.814, respectively. The combined AUC of SOFA scores and PCT was 0.875. Conclusion The combined test of SOFA and PCT can predict the condition and prognosis of sepsis patients. -
Key words:
- Sequential organ failure assessment scores /
- Procalcitonin /
- Sepsis
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表 1 2组脓毒症患者一般基线指标比较
(例) 组别 例数 性别
(男/女)年龄
(x±s, 岁)原发感染 肺部 腹部 泌尿道 脓毒症组 19 10/9 62.21±12.75 9 6 4 脓毒症休克组 21 11/10 67.11±13.29 7 9 5 统计量 < 0.001a 24.495b 0.863a P值 0.987 0.322 0.649 注：a为χ2值，b为t值。 
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表 2 脓毒症组与脓毒症休克组患者观察指标比较
(x ±s) 组别 例数 SOFA评分(分) PCT(ng/mL) 第1天 第5天 第1天 第5天 脓毒症组 19 10.05±2.32 7.11±2.69 30.78±33.15 4.42±5.59 脓毒症休克组 21 12.57±2.68 11.63±4.04 40.26±38.42 12.58±14.12 t值 -3.107 -2.989 -0.736 -2.169 P值 0.006 0.008 0.471 0.044
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表 3 存活组和死亡组观察指标比较
(x ±s) 组别 例数 SOFA评分(分) PCT(ng/mL) 第1天 第5天 第1天 第5天 存活组 22 11.86±2.77 8.36±1.87 34.38±26.30 3.37±2.96 死亡组 18 10.83±2.12 13.22±2.84 23.50±27.37 12.50±9.49 t值 1.444 -5.976 1.301 -3.099 P值 0.168 < 0.001 0.212 0.007
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