中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (07): 493-497.doi: 10.3969/j.issn.1671-4091.2023.07.004

• 临床研究 • 上一篇    下一篇

血液净化治疗启动时机及滤器选择对脓毒症患者短期预后的影响

陈 希   万宏哲    吴 硕   张 丽   

  1. 830011 乌鲁木齐，1新疆医科大学第一附属医院肾脏病中心 新疆肾脏替代治疗临床研究中心 国家肾脏疾病临床医学研究中心新疆分中心 新疆维吾尔自治区血液净化质量控制中心 新疆维吾尔自治区肾脏病研究所 518105 深圳，2深圳市宝安区松岗人民医院肾病内科
  • 收稿日期:2022-12-16 修回日期:2023-05-04 出版日期:2023-07-12 发布日期:2023-07-12
  • 通讯作者: 张丽 E-mail:13379770508@qq.com
  • 基金资助:
    新疆维吾尔自治区自然科学基金重点项目(2022D01D61)；国家自然科学基金(81960145)；新疆维吾尔自治区研究生科研创新项目(XJ2022G173)

Effect of the start time of blood purification therapy and the selection of filter on short-term prognosis of the patients with sepsis

CHEN Xi, WAN Hong-zhe, WU Shuo, ZHANG Li   

  1. ephrology Center, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Research Center of Renal Replacement Therapy, Xinjiang Branch of National Clinical Research Center For Kidney Disease, Xinjiang Blood Purification Medical Quality Control Center, Institute of Nephrology of Xinjiang, Urumqi 830011, China; 2Department of Nephrology, Shenzhen Baoan District Songgang People’s Hospital, Shenzhen 518105, China
  • Received:2022-12-16 Revised:2023-05-04 Online:2023-07-12 Published:2023-07-12
  • Contact: 830011 乌鲁木齐，1新疆医科大学第一附属医院肾脏病中心 新疆肾脏替代治疗临床研究中心国家肾脏疾病临床医学研究中心新疆分中心 新疆维吾尔自治区血液净化质量控制中心 新疆维吾尔自治区肾脏病研究所 Emall:zhanglily1030@163.com E-mail:13379770508@qq.com

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摘要： 目的  探讨血液净化治疗启动时机及滤器选择对脓毒症患者短期预后的影响。方法 回顾性收集新疆医科大学第一附属医院收治的接受血液净化治疗的脓毒症患者。收集其启动当天的相关指标进行单因素分析，用ROC曲线对比各指标的预测效果，确定最佳临界值并用其分组，分析使用AN69/oXiris在各界值上/下组中28天死亡率的情况。 结果 共纳入66例患者，入院28天内死亡31例。单因素分析显示年龄校正查尔森合并症指数(age-adjusted Charlson comorbidity index,aCCI)、英国国家早期预警评分(national early warning score,NEWS)、脓毒症相关性器官衰竭评价(sequential ogran failure assessment,SOFA)、急性生理学和慢性健康评估II(acute physiology and chronic health evaluation system,APACHEⅡ)(OR值依次为1.380、1.213、1.141、1.079，95% CI：依次为1.035～1.838、1.062～1.386、1.005～1.297、1.017～1.144，P值依次为0.028、0.005、0.042、0.012)是28天内死亡的危险因素；肌酐(Scr)(OR=0.994，95% CI：0.991～0.998，P=0.001)是28天内死亡的保护因素；aCCI、NEWS、SOFA、APACHE II、Scr的AUC分别为0.674、0.698、0.657、0.679、0.736，95%CI：分别为0.543～0.806、0.572～0.824、0.521～0.793、0.548～0.811、0.614～0.858，最佳界值分别为3.5分、14.5分、11.5分、19.5分、418.98 μmol/L。低aCCI组使用oXiris治疗的患者，28天死亡率更低(χ2=4.572，P=0.032)。 结论  血液净化治疗启动时脓毒症患者的aCCI在3.5分以上、NEWS在14.5分以上、SOFA在11.5分以上、APACHE II在19.5分以上、Scr在418.98μmol/L以下28天内死亡风险越高。脓毒症患者在aCCI较低时，选用oXiris治疗与AN69膜材相比，可降低脓毒症患者28天死亡率。

关键词: 脓毒症, 预后, 年龄校正查尔森合并症指数, oXiris

Abstract: Objective  To investigate the effect of starting time of blood purification therapy and selection of filter on short-term prognosis of patients with sepsis. Methods:We retrospectively collected Patients with sepsis who received blood purification treatment in the First Affiliated Hospital of Xinjiang Medical University .Single factor analysis was collected on the index line on the start day.ROC curve was used to compare the prediction effect of each index, and the optimal threshold value was determined and grouped to analyze the 28d mortality rate with AN69/oXiris was analyzed in the higher/lower groups with different cut-off values. P＜0.05 was considered statistically significant. Results:Among the 66 patients, 31 died within 28 days of admission. Univariate analysis showed that aCCI, NEWS, SOFA, APACHE II(OR value was 1.380, 1.213, 1.141, 1.079; 95%CI was 1.035-1.838, 1.062-1.386, 1.005-1.297, 1.017-1.144; and P value was 0.028, 0.005, 0.042, 0.012) was the risk factor for death within 28 days; Scr(OR=0.994;95%CI=0.991-0.998;P=0.001) was a protective factor for death within 28 days; The AUC vaule of aCCI, NEWS, SOFA, APACHE II and Scr were 0.674, 0.698, 0.657, 0.679 and 0.736. 95%CI were 0.543-0.806、0.572-0.824、0.521-0.793、0.548-0.811、0.614-0.858, and the optimal cut-off values were 3.5, 14.5, 11.5, 19.5 and 418.98. In the low-aCCI group, 28d mortality was lower in patients treated with oXiris(χ2=4.572，P=0.032). Conclusion: 1. Patients with sepsis at the start of blood purification therapy had higher risk of death within 28 days with aCCI score above 3.5, NEWS score above 14.5, SOFA score above 11.5, APACHE II score above 19.5, and Scr score below 418.98μmol/L. 2. In sepsis patients with low aCCI, oXiris treatment compared with AN69 membrane material can reduce the 28d mortality of sepsis patients.

Key words: Sepsis, Prognosis, Age-adjusted Charlson comorbidities index, oXiris filter

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