Prognostic value of coagulation function combined with acute physiology and chronic health evaluationⅡ and sequential organ failure assessment scores for patients with bloodstream infection
10.3760/cma.j.cn121430-20210910-01361
- VernacularTitle:凝血功能联合APACHEⅡ及SOFA评分对血流感染患者预后的预测价值
- Author:
Mingyue YANG
1
;
Xiaojuan YANG
;
Pei JING
;
Xiaojun YANG
;
Zhijun ZHAO
Author Information
1. 宁夏医科大学临床医学院,银川 750000
- Keywords:
Intensive care unit;
Coagulation function;
Disease severity score;
Bloodstream infection;
Prognostic value
- From:
Chinese Critical Care Medicine
2021;33(12):1434-1439
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the prognostic value of platelet count (PLT), coagulation indexes, acute physiology and chronic health evaluationⅡ(APACHEⅡ), and sequential organ failure assessment (SOFA) in patients with bloodstream infection.Methods:A retrospective single center cohort study was conducted, patients with at least one positive blood culture bloodstream infection hospitalized in the intensive care unit (ICU) of Ningxia Medical University General Hospital from January 2016 to October 2020 were selected as the research objects, basic data and pathogen distribution, coagulation function, and prognosis at 28 days were collected, the APACHEⅡscore, SOFA score based on the results of laboratory examination within 24 hours of blood culture were calculated. Patients were divided into the survival group and the death group according to the 28-day prognosis, and the differences of the above indicators were compared. Multivariate Logistic regression analysis was used to screen out the risk factors for 28-day death of patients with bloodstream infection. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive efficacy of various risk factors for 28-day prognosis of patients with bloodstream infection.Results:A total of 215 patients with bloodstream infection were enrolled, of which 117 survived and 98 died within 28 days. The 256 strains of pathogenic bacteria were detected, including 161 (62.89%) Gram-negative bacteria (G -), 76 (29.69%) Gram-positive bacteria (G +), 17 fungi (6.64%), and 2 other strains (0.78%). The main pathogenic bacteria were Escherichia coli (53 strains, 20.70%), Enterococcus (37 strains, 14.45%), and Klebsiella pneumoniae (34 strains, 13.28%). Compared with the survival group, patients in the death group were older (years old: 60.98±16.08 vs. 55.64±16.35), had higher levels of body temperature, SOFA score, APACHEⅡ score, proportion of malignant tumor and pulmonary infection, blood lactic acid (Lac), and creatinine [Cr; body temperature (℃): 39.12±1.10 vs. 38.67±1.09, SOFA score: 13.05±4.40 vs. 7.85±3.74, APACHEⅡscore: 24.01±8.18 vs. 15.38±6.59, proportion of malignant tumor: 15.31% (15/98) vs. 12.82% (15/117), proportion of patients with pulmonary infection: 84.69% (83/98) vs. 72.65% (85/117), Lac (mmol/L): 7.13±6.04 vs. 4.31±2.98, Cr (μmol/L): 189.73±141.81 vs. 124.55±106.17, all P < 0.05]. The prothrombin time (PT), activated partial thrombin time (APTT), and thrombin time (TT) were significantly longer [PT (s): 19.51±15.16 vs. 14.94±2.86, APTT (s): 52.74±26.82 vs. 40.77±15.30, TT (s) : 21.59±18.46 vs. 17.38±2.59, all P < 0.05], PLT was significantly decreased [×10 9/L: 43.50 (18.75, 92.75) vs. 86.00 (36.00, 154.50), P < 0.05]. Logistic regression analysis showed that body temperature, age, SOFA score and APACHEⅡ score were independent risk factors [odds ratio ( OR) were 1.388, 1.023, 0.817 and 0.916, respectively, 95% confidence intervals (95% CI) were 1.001-1.926, 1.001-1.046, 0.730-0.913, 0.867-0.968, with respective P values of 0.046, 0.043, 0.000, 0.002]. ROC curve analysis showed that SOFA score, APACHEⅡ score, temperature, age had certain predictive values for the prognosis of patients with bloodstream infection, and area under ROC curve (AUC) was 0.815, 0.795, 0.625 and 0.594, respectively (all P < 0.05). The AUC predicted by the combination of the 4 variables was as high as 0.851, the specificity was 79.3%, and the sensitivity was 74.2%, suggesting that the combination variables could predict the death of patients with bloodstream infection with higher accuracy. Conclusions:PLT and coagulation indexes are helpful to evaluate the prognosis of patients with bloodstream infection in ICU. APACHEⅡscore and SOFA score are directly related to the prognosis of patients with bloodstream infection.