总甲状腺素联合D-二聚体、尿酸预测老年脓毒性休克病人28 d预后的价值

doi:10.3969/j.issn.1003-9198.2023.08.015

摘要/Abstract

摘要： 目的探索总甲状腺素(TT4)联合D-二聚体、尿酸预测老年脓毒性休克病人28 d天预后的价值。方法采用回顾性研究方法,收集我院住院的老年脓毒性休克病人的临床资料,根据28 d预后分为生存组(46例)和死亡组(32例)。应用多因素Logistic回归分析影响预后的危险因素并建立预测模型,计算模型的区分度和校准度;应用AUC比较预测模型和序贯器官功能衰竭评估(SOFA)评分预测病人预后的价值。结果 Logistic回归显示,TT4、D-二聚体和尿酸是影响老年脓毒性休克病人28 d预后的独立危险因素(P<0.05),预测模型Y=-3.811-0.553×TT4+0.289×D-二聚体+0.013×尿酸;模型的灵敏度为91.67%,特异度为94.12%,区分度为0.961,校准度曲线r²=0.991,P=0.887,AUC为0.961(95%CI:0.889~0.991),大于SOFA评分的AUC 0.833(95%CI:0.706~0.959)(P<0.05)。结论 TT4联合D-二聚体、尿酸对老年脓毒性休克病人28 d预后有较好的预测价值。

关键词: 总甲状腺素, 老年人, 脓毒性休克, 预后

Abstract: Objective To explore the value of total tetraiodothyronine(TT4) combined with D-dimer and uric acid in predicting the 28-d prognosis in the elderly patients with septic shock. Methods A retrospective study was conducted to collect the clinical data of the elderly patients with septic shock. According to the 28-d prognosis, all patients were divided into survival group(46 cases) and death group(32 cases). Multivariate Logistic regression was used to analyze the risk factors of prognosis. A prediction model was established, and the discrimination and calibration of the model were calculated; Receiver operator characteristic(ROC) curve was used to assess the predictive value of the prediction model and the Sequential Organ Failure Assessment(SOFA) score. Results Logistic regression showed TT4, D-dimer and uric acid were the independent risk factors of the 28-d prognosis in the elderly patients with septic shock(P<0.05) and a predictive model was established: Y=-3.811-0.553×TT4+0.289×D-dimer+0.013×uric acid. ROC curve showed that the sensitivity and specificity of the predictive model was 91.67%, 94.12%, respectively, with discrimination of 0.961, calibration curve r²=0.991(P=0.887). The area under the ROC curve (AUC) of the model for predicting the prognosis was 0.961(95%CI: 0.889-0.991), which was higher than that of SOFA score (AUC=0.833,95%CI: 0.706-0.959)(P<0.05). Conclusions TT4-related prediction model has a good predictive value for the 28-d prognosis in the elderly patients with septic shock.

Key words: total thyroxine, aged, septic shock, prognosis

中图分类号:

R 459.7

张剑, 李全瑞, 田耕. 总甲状腺素联合D-二聚体、尿酸预测老年脓毒性休克病人28 d预后的价值[J]. 实用老年医学, 2023, 37(8): 815-818.

ZHANG Jian, LI Quan-rui, TIAN Geng. Value of total tetraiodothyronine combined with D-dimer and uric acid in predicting the 28-d prognosis in elderly patients with septic shock[J]. Practical Geriatrics, 2023, 37(8): 815-818.

参考文献

[1] 孙静静, 王长强, 冉宇. 老年重症肺炎合并脓毒性休克病人预后影响因素分析[J]. 实用老年医学, 2020, 34(5):439-442.
[2] VINCENT J L, MORENO R, TAKALA J, et al. The SOFA(Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure[J]. Intensive Care Med, 1996, 22(1):707-710.
[3] 张越新, 张玲, 郭贤庆. PCT、CRP、血乳酸、APACHE-Ⅱ、SOFA评分在脓毒症患者疾病严重程度及预后评估中的价值研究[J]. 中国急救医学, 2017, 9(12):302-303.
[4] 中国医师协会急诊医师分会中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 中国急救医学, 2018, 38(9):741-756.
[5] 徐维, 李茂芹. 感染性休克患者甲状腺素、ACTH、皮质醇水平与组织能量代谢失衡和预后的相关性分析[J]. 河北医药, 2016, 38(9):1351-1353.
[6] 孙维维, 韩旭东, 黄晓英. 甲状腺功能与ICU感染性休克患者预后的相关性[J]. 南通大学学报(医学版), 2014, 34(1):43-45.
[7] 王剑, 郭晋平, 吕广欣. 危重症患者血清甲状腺激素水平变化及意义[J]. 山东医药, 2016, 56(12):83-85.
[8] 王秀梅, 宋丽洁, 张金红. 正常甲状腺病态综合征[J]. 中国急救复苏与灾害医学杂志, 2013, 8(6):564-566.
[9] FLIERS E, BOELEN A. An update on non-thyroidal illness syndrome[J]. J Endocrinol Invest, 2021, 44(8):1597-1607.
[10] 中华医学会老年医学分会老年内分泌代谢疾病学组. 中国老年人甲状腺疾病诊疗专家共识(2021)[J]. 中华内分泌代谢杂志, 2021, 37(5):399-418.
[11] 尚小燕, 马君媛, 杨寅芳. 血清PCT、D-二聚体、NT-proBNP水平对感染性休克患者病情的评估研究[J]. 解放军医药杂志, 2020, 32(8):62-65.
[12] 孔燕南, 林锦喜, 王孔专, 等. 降钙素原、C-反应蛋白、D-二聚体与乳酸联合检测在感染性休克患者中的临床价值[J]. 吉林医学, 2022, 43(5):1354-1355.
[13] 刘冰, 王国兴, 孙雪莲. 血清降钙素原和D-二聚体检测在急诊脓毒症患者病情及预后评估中的应用价值[J]. 临床和实验医学杂志, 2020, 19(3):310-313.
[14] 李佳, 徐钰, 王优雅, 等. 老年流感肺炎的临床特征及D-二聚体与疾病严重程度的相关性[J]. 北京大学学报(医学版), 2022, 54(1):153-160.
[15] AKBAR S R, LONG D M, HUSSAIN K, et al. Hyperuricemia: an early marker for severity of illness in seps[J]. Int J Nephrol, 2015:301021.
[16] VERA S, MARTÍNEZ R, GORMAZ J G, et al. Novel relation between oxidative stress and angiogenesis related factors in sepsis: new biomarkers and therapies[J]. Ann Med, 2015, 47(4):289-300.
[17] 高兰, 李昊, 刘红娟, 等. 尿酸联合红细胞分布宽度对脓毒症患者短期结局的预测价值[J]. 中华危重症医学杂志:电子版, 2019,12(6):367-371.