右心室损伤评分对老年脓毒症患者院内结局的预测价值^*

Predictive value of right ventricular injury score for in-hospital outcome in elderly patients with sepsis

摘要

目的 探讨基于超声心动图的右心室损伤 (RVI) 评分对老年脓毒症患者院内结局的预测价值。方法 选取 2021 年 1 月—2023 年 10 月上海交通大学医学院附属第九人民医院收治的 86 例老年脓毒症患者作为研究对象, 按照院内是否出现死亡分为死亡组 (18 例) 和生存组 (68 例)。采用多因素 logistic 回归模型分析老年脓毒症患者院内结局的影响因素, 采用 ROC 曲线分析 RVI 评分对老年脓毒症患者院内结局的预测价值。结果 生存组与死亡组的机械通气、合并症、尿素氮、降钙素原、活化部分凝血酶时间、凝血酶原时间、急性生理学及慢性健康状况评分 (APACHE^Ⅱ)、RVI 评分比较, 差异均有统计学意义 (P<0.05); 以上指标作为因变量进行多因素 logistic 回归分析, 结果显示: 尿素氮 (OR=3.726, 95%CI: 1.538~9.028)、降钙素原 (OR=1.125, 95%CI: 1.068~1.185)、APACHE^Ⅱ(OR=1.912, 95%CI: 1.457~2.510)、RVI 评分 (OR=16.087, 95%CI: 2.639~98.059) 均为老年脓毒症患者院内死亡的独立影响因素 (P<0.05); ROC 曲线显示, RVI 评分预测脓毒症患者院内死亡风险的 AUC 为 0.853 (95%CI: 0.750~0.956), 灵敏度为 0.833, 特异度为 0.926, 最大约登指数为 0.759, 最佳阈值为 1.935 分。结论 基于超声心动图的 RVI 评分在老年脓毒症患者院内结局预测具有较高的预测价值, 可作为院内结局风险评估的重要指标之一。

Abstract

Objective To investigate the value of right ventricular injury (RVI) score based on echocardiography in predicting in-hospital outcome in elderly patients with sepsis. Methods A total of 86 elderly patients with sepsis admitted to Shanghai Ninth People's Hospital from January 2021 to October 2023 were selected as the subjects of this study and divided into death group (18 cases) and survival group (68 cases) according to whether death occurred in the hospital. Multivariate logistic regression analysis was conducted to analyze the influencing factors of in-hospital outcomes of elderly patients with sepsis. ROC curve analysis of the predictive value of RVI score in in-hospital outcomes of elderly patients with sepsis. Results There were significant differences in mechanical ventilation, complications, urea nitrogen, procalcitonin, activated partial thrombin time, prothrombin time, acute physiology and chronic health status score (APACHE Ⅱ), and RVI score between the survival group and the death group (P<0.05); multivariate logistic regression analysis was performed with the above indicators as dependent variables, and the results showed that urea nitrogen (OR=3.726, 95%CI: 1.538 to 9.028), procalcitonin (OR=1.125, 95%CI: 1.068 to 1.185), APACHE Ⅱ(OR=1.912, 95%CI: 1.457 to 2.510), and RVI score (OR=16.087, 95%CI: 2.639 to 98.059) were independent factors for in-hospital death in elderly patients with sepsis (P<0.05); ROC curve showed that the AUC of RVI score in predicting the risk of in-hospital death in patients with sepsis was 0.853 (95%CI: 0.750 to 0.956), the sensitivity was 0.833, the specificity was 0.926, the maximum Youden index was 0.759, and the optimal threshold was 1.935 scores. Conclusion Echocardiography-based RVI score has a high predictive value in predicting in-hospital outcomes in elderly patients with sepsis and can be used as one of the important indicators for in-hospital outcome risk assessment.

关键词

脓毒症 / 右心室损伤评分 / 院内结局 / 超声心动图

Key words

Sepsis / Right ventricular injury score / In-hospital outcome / Echocardiography

参考文献

[1] 王九菊, 闫杜娟, 曹楠婧, 等 . 基于细胞因子、免疫因子构建老年脓毒症预后的 Nomogram 预测模型[J]. 中国急救复苏与灾害医学杂志, 2024, 19(5): 607-611.

[2] Wang J J, Yan D J, Cao N J, et al. Construction of a Nomogram prognostic model of senile sepsis based on cytokines and immune factors[J]. Chin J Emerg Resusc Dister Med, 2024, 19(5): 607-611.

[3] Wu J, Liang J, An S, et al. Novel biomarker panel for the diagnosis and prognosis assessment of sepsis based on machine learning[J]. Biomark Med, 2022, 16(15): 1129-1138.

[4] 张凯军, 朱文舜, 卢晓乐, 等 . 老年脓毒症患者胃镜下改良 Lanza 评分与预后的关系[J]. 中华消化内镜杂志, 2023, 40(11): 909-914.

[5] Zhang K J, Zhu W S, Lu X L , Correlation between modified Lanza score under gastroscopy and prognosis of sepsis in geriatric patients[J]. Chin J Dig Endosc, 2023, 40(11): 909-914.

[6] Bowcock E M, Gerhardy B, Huang S, et al. Right ventricular outflow tract Doppler flow analysis and pulmonary arterial coupling by transthoracic echocardiography in sepsis: a retrospective exploratory study[J]. Crit Care, 2022, 26(1): 303.

[7] El Tahlawi M, Morsy M, Elawady M, et al. Is there any relationship between biomarkers and echocardiographic markers in patients with pulmonary stenosis underwent balloon valvuloplasty?[J]. Echocardiography, 2021, 38(6): 924-931.

[8] Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J]. Intensive Care Med, 2021, 47(11): 1181-1247.

[9] Zhang H, Zhang D, Wang X, et al. Prognostic implication of a novel right ventricular injury score in septic patients[J]. ESC Heart Fail, 2023, 10(2): 1205-1213.

[10] Vallabhajosyula S, Kumar M, Pandompatam G, et al. Prognostic impact of isolated right ventricular dysfunction in sepsis and septic shock: an 8—year historical cohort study[J]. Ann Intensive Care, 2017, 7(1): 94.

[11] Lanspa M J, Cirulis M M, Wiley B M, et al. Right ventricular dysfunction in early sepsis and septic shock[J]. Chest, 2021, 159(3): 1055-1063.

[12] Bansal S, Varshney S, Shrivastava A . A prospective observational study to determine incidence and outcome of sepsis—induced cardiomyopathy in an intensive care unit[J]. Indian J Crit Care Med, 2022, 26(7): 798-803.

[13] Dugar S, Sato R, Chawla S, et al. Is left ventricular systolic dysfunction associated with increased mortality among patients with sepsis and septic shock?[J]. Chest, 2023, 163(6): 1437-1447.

[14] 韩永燕, 杨俊礼, 孟会敏, 等 . 血尿素氮/白蛋白比值联合可溶性生长刺激表达基因 2 蛋白对急诊重症监护病房老年脓毒症患者心肌损伤的预警价值[J]. 中华老年医学杂志, 2024, 43(6): 727-732.

[15] Han Y Y, Yang J L, Meng H M, et al. Early warning value of blood urea nitrogen to albumin ratio combined with soluble growth stimulation expressed gene 2 on sepsis—induced myocardial injury in elderly patients in emergency intensive[J]. Chin J Geriatr, 2024, 43(6): 727-732.

[16] Li X, Li T, Wang J, et al. Higher blood urea nitrogen level is independently linked with the presence and severity of neonatal sepsis[J]. Ann Med, 2021, 53(1): 2192-2198.

[17] 刘慧琳, 傅义程, 郝靖欣, 等 . 血清降钙素原水平和 APACHE ^Ⅱ评分对老年脓毒症患者预后的预测价值分析 [J]. 中华危重病急救医学, 2023, 35(1): 56-60.

[18] Liu H L, Fu Y C, Hao J X, et al. Value of serum procalcitonin and acute physiology and chronic health evaluation Ⅱ score on predicting the prognosis of sepsis in elderly patients[J]. Chin Crit Care Med, 2023, 35(1): 56-60.

[19] 赵刚, 郁红萍, 张一凡 . 降钙素原与 D—二聚体联合序贯器官衰竭评分对老年脓毒症患者病情及预后评估的价值[J]. 中华老年多器官疾病杂志, 2021, 20(5): 355-358.

[20] Zhao G, Yu H P, Zhang Y F. Value of procalcitonin and D—dimer combined sequential official failure score in evaluation of elderly patients with sepsis and their prognosis[J]. Chin J Mult Organ Dis Elderly, 2021, 20(5): 355-358.

[21] Zhang J, Yang J, Xu X, et al. The influence of genetic polymorphisms in TLR4 and TIRAP, and their expression levels in peripheral blood, on susceptibility to sepsis[J]. Exp Ther Med, 2016, 11(1): 131-139.

[22] Zhao L, Yu S, Wang L, et al. BloodsuPAR, Th1 and Th17 cell may serve as potential biomarkers for elderly sepsis management[J]. Scand J Clin Lab Invest, 2021, 81(6): 488-493.

基金资助

^*国家自然科学基金项目(82070401)