系统免疫炎症指数评估脓毒症严重程度和预后临床研究

Clinical value of systemic immune-inflammation index in assessing the severity and prognosis of sepsis

摘要:

目的：探讨系统免疫炎症指数（systemic immune-inflammation index，SII）对脓毒症患者病情严重程度判断及预后评估的临床价值。方法：选择57名脓毒症患者为研究对象，患者按病情严重程度分为脓毒症组（30例）和脓毒性休克组（27例）；根据28 d预后分为生存组（48例）和死亡组（9例）。记录患者入ICU时的SII、降钙素原（procalcitonin，PCT）、急性生理学与慢性健康状况评分系统Ⅱ评分（acute physiology and chronic health evaluation Ⅱscore，APACHE Ⅱ）及序贯器官衰竭评分（sequential organ failure assessment，SOFA）。比较脓毒症组、脓毒性休克组间SII、血PCT、APACHE Ⅱ及SOFA的差异。Spearman法分析各指标间的相关性。受试者工作特征（receiver operating characteristic，ROC）曲线分析SII、PCT、APACHE Ⅱ及SOFA对脓毒症患者预后评估的临床价值。结果：脓毒症组患者SII为[391.62（343.18，492.00）]×109/L，低于脓毒性休克组[1 454.17（689.96，2 467.52）]×109/L（P<0.05）。脓毒症组患者血PCT为[10.03（1.02，51.47）] ng/mL，脓毒性休克组[12.56（2.00，53.57）] ng/mL，两者没有统计学差异（P＞0.05）。死亡组患者SⅡ、APACHE Ⅱ及SOFA均高于生存组（P<0.05）；而血PCT水平在生存组和死亡组之间没有统计学差异（P＞0.05）。Spearman相关分析分别分析SII与APACH Ⅱ、SOFA的相关性，SII与APACH Ⅱ进行相关性分析（r=0.628，P=0.001）；脓毒症患者SII与SOFA进行相关性分析（r=0.638，P=0.001）。根据ROC曲线分析，SII的ROC曲线下面积（area under the ROC curve，AUC）为0.914（P＜0.05），PCT的AUC为0.519（P＞0.05），APACHE Ⅱ与SOFA的AUC均为0.868（P＜0.05）。SII其截断值0.743。结论：SII有助于早期对脓毒症患者进行病情严重程度的判断和预后评估。

Abstract:

Objective：To investigate the clinical value of systemic immune-inflammation index（SII） in assessing disease severity and prognosis in patients with sepsis. Methods：A total of 57 patients with sepsis were enrolled as subjects. According to disease severity，these patients were divided into sepsis group with 30 patients and septic shock group with 27 patients；according to 28-day outcome，the patients were divided into survival group with 48 patients and death group with 9 patients. Related data were recorded at the time of admission to the intensive care unit，including SII，procalcitonin（PCT），Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ） score，and Sequential Organ Failure Assessment（SOFA） score. The sepsis group and the septic shock group were com－pared in terms of SII，blood PCT，APACHE Ⅱ，and SOFA. Spearman analysis was used to investigate the correlation between these in－dices. The receiver operating characteristic（ROC） curve was used to analyze the clinical value of SII，PCT，APACHE Ⅱ，and SOFA in evaluating the prognosis of patients with sepsis. Results：The sepsis group had a significantly lower SII than the septic shock group{[391.62（343.18，492.00）]×109/L vs. [1 454.17（689.96，2 467.52）]×109/L，P<0.05}. The sepsis group had a lower blood PCT level than the septic shock group{[10.03（1.02，51.47）] ng/mL vs. [12.56（2.00，53.57）] ng/mL，P>0.05}. The death group had significantly higher SII，APACHEⅡ score，and SOFA score than the survival group（P<0.05），while there was no sig－nificant difference in blood PCT level between the two groups（P>0.05）. The Spearman correlation analysis showed that SII was posi－tively correlated with APACHEⅡ score（r=0.628，P=0.001） and that SII was positively correlated with SOFA score in the patients with sepsis（r=0.638，P=0.001）. The ROC curve analysis showed that SII had an area under the ROC curve（AUC） of 0.914（P<0.05），PCT had an AUC of 0.519（P>0.05），and APACHEⅡ and SOFA had an AUC of 0.868（P<0.05）；SII had a cut-off value of 0.743. Conclusion：SII helps with early evaluation of disease severity and prognosis in patients with sepsis.