快速序贯器官功能衰竭评分对肝硬化脓毒血症患者的预后评估价值

摘要/Abstract

摘要： 目的探讨快速序贯器官功能衰竭(qSOFA)评分对失代偿期肝硬化(DLC)脓毒症患者预后评估的价值。方法纳入2017年5月至2021年5月北京市应急总医院收治的DLC合并脓毒症患者65例。根据治疗结局不同分为死亡组和存活组。比较两组一般资料以患者死亡作为不良预后指标,采用受试者工作特征曲线分析qSOFA评分、MEWS评分和Child-Pugh分级评分对患者预后的评估效能。结果存活、死亡组分别为39例、26例。存活组WBC、CRP、PCT和PLT分别为(11.8±2.9)×10⁹/L、(32.0±12.9)mg/L、(2.9±0.3)ng/mL和(112.9±37.0)×10⁹/L,死亡组患者分别为(14.3±1.8)×10⁹/L、(67.7±28.4)mg/L、(5.7±2.2)ng/mL和(63.5±23.7)×10⁹/L,差异均有统计学意义(均P<0.05);存活组PT、INR为(18.3±6.3)s、(1.2±0.2),死亡组为(22.8±9.7)s、(2.5±1.0)],差异有统计学意义(P<0.05);存活组ALT、血氨及总胆红素为(163.8±35.7)U/L、(36.3±12.7)μmol/L和(58.2±18.1)μmol/L,死亡组为(498.2±163.5)U/L、(82.4±8.2)μmol/L及(231.5±75.4)μmol/L],差异有统计学意义(P<0.05);存活组qSOFA评分、Child-Pugh评分及MEWS评分为(1.1±0.4)分、(6.1±2.1)分及(6.3±2.6)分,死亡组为(2.3±0.5)分、(7.9±0.8)分和(9.8±1.8)分,差异有统计学意义(P<0.05)。qSOFA 评分、MEWS评分和Child-Pugh评分评估患者28 d内死亡的AUC分别为0.68、0.73和0.67;敏感度分别为89.7%、97.4% 和84.6%;特异度分别为46.2%、88.5%和65.4%。结论 qSOFA评分对肝硬化脓毒症患者的预后快速评估具有一定的临床意义,其评估效能与MEWS评分以及Child-Pugh分级评分大致相仿,特异度不及MEWS评分和Child-Pugh分级评分。

关键词: 快速序贯器官功能衰竭评分, 失代偿性肝硬化, 脓毒血症, MEWS评分, Child-Pugh分级

Abstract: Objective To investigate the prognostic value of quick sequential organ failure assesment (qSOFA) score in decompensated liver cirrhosis (DLC) patients combined with sepsis, and to provide clinical theoretical basis in early rapid assessment. Methods Sixty-five DLC patients combined with sepsis from May 2017 to May 2021 were included (41 males and 24 females). They were divided into death group and survival group according to the different treatment outcomes. Taking death as an indicator of adverse prognosis, receiver operating characteristic curve was used to analyze the clinical value of qSOFA score, modified early warning score (MEWS) and Child-Pugh score in evaluating the prognosis of patients. Results There were 39 cases and 26 cases in the survival and death groups, respectively. The serum levels of white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT) and platelet (PLT) in the survival group were (11.8±2.9)×10⁹/L, (32.0±12.9) mg/L, (2.9±0.3) ng/mL and (112.9±37.0)×10⁹/L, respectively. The serum levels of WBC, CRP, PCT and PLT in the death group were (14.3±1.8)×10⁹/L, (67.7±28.4) mg/L, (5.7±2.2) ng/mL and (63.5±23.7)×10⁹/L, respectively. The differences between the 2 groups were statistically significant (P<0.05). The prothrombin time (PT) and international normalized ratio (INR) in survival group were (18.3±6.3) s and (1.2±0.2), which were significantly different from those in death group [(22.8±9.7) s and (2.5±1.0)] (P<0.05). The alanine transaminase (ALT), blood ammonia and total bilirubin (TBiL) in the survival group were (163.8±35.7) U/L, (36.3±12.7) μmol/L and (58.2±18.1) μmol/L, which were significantly higher than those in the death group [(498.2±163.5) U/L, (82.4±8.2) μmol/L and (231.5±75.4) μmol/L] (P<0.05). The qSOFA score, Child-Pugh score and MEWS in the survival group were (1.1±0.4), (6.1±2.1) and (6.3±2.6), which were significantly higher than those in the death group [(2.3±0.5), (7.9±0.8) and (9.8±1.1)] (P<0.05). The area under the curve (AUC) of qSOFA score, MEWS and Child-Pugh score were 0.68, 0.73 and 0.67, respectively. Sensitivity were 89.7%, 97.4% and 84.6%, respectively. Specificity were 46.2%, 88.5% and 65.4%, respectively. Conclusion There is clinical significant of the qSOFA score in evaluating the prognosis of DLC patients combined with sepsis. The evaluation efficacy of qSOFA score is similar to MEWS and Child-Pugh score, but the specificity of qSOFA score is lower than that of MEWS and Child-Pugh score.

Key words: Quick sequential organ failure assessment score, Decompensated cirrhosis, Sepsis, Modified early warning score, Child-Pugh grading

王青, 翁艳, 陈一文, 金长明, 孙晶. 快速序贯器官功能衰竭评分对肝硬化脓毒血症患者的预后评估价值[J]. 肝脏, 2021, 26(12): 1348-1350.

WANG Qing, WENG Yan, CHEN Yi-wen, JIN Chang-ming, SUN Jing. Prognostic value of qSOFA score in liver cirrhosis patients combined with sepsis[J]. Chinese Hepatolgy, 2021, 26(12): 1348-1350.

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