血管活性药物评分联合APACHE II评分对血流感染后脓毒性休克患者预后的预测价值

Prognostic Value of Vasoactive Inotropic Score Combined with APACHE II Score in Patients with Septic Shock after Bloodstream Infection

摘要: 目的：探讨血管活性药物评分(vasoactive inotropic score, VIS)联合急性生理与慢性健康评分(APACHE II)对血流感染后脓毒性休克患者结局的预测价值，为临床提供参考。方法：采用回顾性研究方法，通过收集2020年1月至2022年12月安徽医科大学附属合肥医院重症医学科收治的185例脓毒性休克患者的临床资料，根据28 d转归情况，分为存活组95例和死亡组90例，记录所有患者性别、年龄、相关血液检测指标、SOFA评分、24小时内急性生理与慢性健康评分(APACHE II)及24小时内最大血管活性药物评分(VIS_max24)等信息，采用单因素分析筛选脓毒性休克患者的相关危险因素，多因素logistic回归分析影响脓毒性休克患者预后的独立危险因素，采用受试者工作特征(receiver op-erating characteristic, ROC)曲线下面积(area under curve, AUC)分析各指标的诊断价值。结果：单因素分析结果表明：死亡组的APACHE II评分(24.30 ± 5.157)、VIS_max24 [100.0 (53.5, 121.0)]明显高于存活组(P < 0.05)；多因素分析结果及ROC曲线下面积结果显示：VIS_max24联合APACHE II评分(AUC = 0.848, 95% CI: 0.792~0.905)，较单一的APACHE II评分(AUC = 0.729, 95% CI: 0.655~0.802)、VIS_max24 (AUC = 0.783, 95% CI: 0.709~0.856)、乳酸(AUC = 0.665, 95% CI: 0.587~0.743)、SOFA (AUC = 0.680, 95% CI: 0.602~0.758)预测价值更高。结论：VISmax24联合APACHE II评分能更有效预测血流感染后脓毒性休克患者的预后。

Abstract: Objective: To study the predictive value of vasoactive-inotropic score (VIS) combined with acute physiology and chronic health evaluation (APACHE II) score for the outcome of patients with septic shock after the bloodstream infections, provide reference for clinical. Methods: A retrospective study was conducted to collect the clinical data of 185 patients with septic shock admitted to the Department of Intensive Care Medicine of Hefei Hospital Affiliated to Anhui Medical University from January 2020 to December 2022. According to the outcome of 28 days, 95 patients were divided in-to a survival group and 90 patients were divided into a death group. Gender, age, relevant blood test indicators, SOFA score, APACHE II score within 24 hours and the maximum vasoactive-inotropic score within 24 hours which were expressed as VIS_max24 of all patients were recorded. Single factor analysis was used to screen the related risk factors of patients with septic shock. Multivariate lo-gistic regression was used to analyze the independent risk factors affecting the prognosis of patients with septic shock. The area under receiver operating characteristic curve was used to analyze the diagnostic value of each indicator. Results: Univariate analysis showed that APACHE II score (24.30 ± 5.157) and VIS_max24 [100.0 (53.5, 121.0)] in the death group were significantly higher than those in the survival group (P < 0.05). The results of multi-factor analysis and the results of area under receiver operating characteristic curve showed that VIS_max24 combined with APACHE II rating (AUC = 0.848, 95% CI: 0.792~0.905), compared with single APACHE II rating (AUC = 0.729, 95% CI: 0.655~0.802), VIS_max24 (AUC = 0.783, 95% CI: 0.709~0.856), lactic acid (AUC = 0.665, 95% CI: 0.587~0.743), SOFA (AUC = 0.680, 95% CI: 0.602~0.758) had higher predictive value. Conclusion: VISmax24 combined with APACHE II score can predict the prognosis of patients with septic shock after bloodstream infection more effectively.