老年脓毒症病人血脂水平与病情严重程度及预后的关系

doi:10.3969/j.issn.1003-9198.2023.11.009

摘要/Abstract

摘要： 目的探讨老年脓毒症病人血脂水平与病情严重程度以及预后的关系。方法回顾性分析南京医科大学附属老年医院2015年1月至2022年1月入住重症监护病房的年龄≥65岁的162例老年脓毒症病人的临床资料, 根据病人28 d结局分为存活组(n=104)和死亡组(n=58),比较2组临床资料及血脂水平差异。分析血脂水平与炎症指标及病情严重程度评分的相关性。绘制血脂及其他临床指标预测28 d死亡预后的ROC曲线。选择AUC最大的血脂指标,取其最佳截断值为界限分组,比较组间预后差异。结果死亡组男性比例、BMI、TC、HDL-C、LDL-C水平均低于存活组(P<0.05)。相关性分析显示,TC、HDL-C、LDL-C均与APACHEⅡ评分及降钙素原(PCT)水平呈负相关,HDL-C与SOFA评分亦呈负相关(P<0.05)。ROC曲线分析显示, HDL-C对老年脓毒症病人28 d死亡预后的预测价值最高(AUC＝0.856),最佳截断值为0.775 mmol/L。与高HDL-C组比较,低HDL-C组28 d病死率、多器官功能障碍发生率、肾脏替代治疗率、多重耐药菌感染率均明显高于高HDL-C组,且机械通气时间和血管活性药物使用时间长于HDL-C组,差异均有统计学意义(P＜0.05)。结论血脂水平尤其是HDL-C水平能够反映老年脓毒症病人病情严重程度,可作为预测老年脓毒症病人预后的良好生物标志物。

关键词: 老年人, 脓毒症, 血脂, 预后

Abstract: Objective To explore the relationship of blood lipids levels with disease severity and prognosis in the elderly patients with sepsis. Methods A retrospective analysis was conducted on the clinical data of 162 elderly patients with sepsis admitted to Intensive Care Unit (ICU) of the Geriatric Hospital of Nanjing Medical University from January 2015 to January 2022. According to the 28-day mortality, the patients were divided into the survival group (n=104) and the death group (n=58). The clinical data and the levels of blood lipids of the two groups were compared. The correlation of blood lipids levels with inflammatory indicators and severity scores of the condition was analyzed. Receiver operating characteristic(ROC)curve of blood lipids and other clinical indicators in predicting the prognosis of the 28-day death was drawn. The patients were divided into 2 groups according to the cut-off value of the blood lipid index with the largest area under the curve (AUC), and the differences in prognosis were compared between the two groups. Results The levels of male ratio, body mass index (BMI), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) in the death group were significantly lower than those in the survival group (P<0.05). The correlation analysis showed that the levels of TC,HDL-C,LDL-C were negatively correlated with Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ)score and the level of procalcitonin(PCT)respectively, and HDL-C was negatively correlated with Sequential Organ Failure Assessmen (SOFA)score as well (P<0.05). ROC curve analysis showed that HDL-C had the highest predictive value (AUC=0.856) for the 28-day mortality, and the best cut-off value was 0.775 mmol/L. The 28-day mortality, incidence rate of multiple organ dysfunction, renal replacement therapy, and multidrug-resistant bacterial infections were significantly higher, and the time of mechanical ventilation and vasoactive drugs usage were longer in the low HDL-C group than those in the high HDL-C group (P<0.05). Conclusions The level of blood lipids, especially HDL-C, can well reflect the severity of elderly patients with sepsis, and it can be used as a good biomarker to predict the prognosis of elderly patients with sepsis.

Key words: aged, sepsis, lipid, prognosis

中图分类号:

R 631.2

卞叶萍, 邓晓静, 佘丽萍, 程惠, 洪雅琳, 徐剑. 老年脓毒症病人血脂水平与病情严重程度及预后的关系[J]. 实用老年医学, 2023, 37(11): 1115-1119.

BIAN Ye-ping, DENG Xiao-jing, SHE Li-ping, CHENG Hui, HONG Ya-lin, XU Jian. Relationship of blood lipids levels with disease severity and prognosis in elderly patients with sepsis[J]. Practical Geriatrics, 2023, 37(11): 1115-1119.

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