入重症监护室早期肌钙蛋白Ⅰ水平对非心脏手术重症患者预后的预测价值

摘要

目的:评估入外科重症监护室(ICU)早期肌钙蛋白I(TnI)水平对非心脏手术重症患者预后的预测价值.方法:连续观察2015-01-01至2015-12-31入住我院外科ICU的非心脏手术重症患者,检测其入ICU早期TnI水平;比较入ICU早期TnI升高患者与TnI正常患者一般临床资料、既往病史、急性生理与慢性健康(APACHE)Ⅱ评分、死亡率,比较存活者与死亡者的入ICU早期TnI水平、一般临床资料、既往病史、APACHEⅡ评分等指标;采用多因素回归分析非心脏手术重症患者ICU死亡的危险因素;采用受试者工作特征(ROC)曲线评价入ICU早期TnI水平及APACHE Ⅱ评分对ICU死亡的预测价值.结果:共入选1193例患者,其中159例(13.3%)入ICU早期TnI水平升高.入ICU早期TnI升高患者的APACHE Ⅱ评分显著高于TnI正常的患者[17.0(14.0,21.0)分 vs 15.0(13.0,18.0)分],前者死亡率也高于后者(18.2% vs 2.6%),差异均有统计学意义(P均=0.000).对死亡者(n=56)与存活者(n=1137)进行单因素比较和多因素回归分析后发现,年龄(OR=1.041)、APACHE Ⅱ评分(OR=1.218)、入ICU早期TnI水平(OR=6.366)为非心脏手术重症患者ICU死亡的独立危险因素(P均<0.05).ROC曲线分析显示,入ICU早期TnI水平及APACHE Ⅱ评分预测ICU死亡的曲线下面积分别为0.763和0.778,两者联合曲线下面积为0.803.结论:入ICU早期TnI升高是非心脏手术重症患者ICU死亡的独立危险因素,对死亡具有预测价值.%Objective: To evaluate the prognostic value of initial troponin Ⅰ (TnI) level in non-cardiac surgery critically ill patients at surgical intensive care unit (ICU). Methods: We consecutively observed non-cardiac surgery critically ill patients admitted in surgical ICU of our hospital from 2015-01-01 to 2015-12-31. TnI level was measured at the early ICU admission, general clinical data, previous history, acute physiology and chronic health evaluation (APACHE) Ⅱ score and mortality were compared between the patients with elevated TnI and normal TnI; TnI level at the early ICU admission, general clinical data, previous history and APACHE Ⅱ score were compared between survival patients and deceased patients. Risk factors for ICU mortality were studied by multivariable regression analysis;predictive values for initial TnI level and APACHE Ⅱ score in mortality were assessed by receiver operating curve (ROC). Results: A total of 1 193 patients were enrolled and 159 (13.3%) of them had TnI elevation upon ICU admission. Compared with normal TnI patients, TnI elevated patients had the higher APACHE Ⅱ score [17.0 (14.0-21.0) vs 15.0 (13.0-18.0)] and ICU mortality (18.2% vs 2.6%), both P=0.000. There were 56 patients died and 1 137 survived, single and multivariable regression analysis indicated that age (OR=1.041), APACHE Ⅱ score (OR=1.218) and initial TnI level (OR=6.366) were the independent risk factors for ICU mortality, all P<0.05. AUC of ROC for predictive value of ICU mortality in APACHE Ⅱ score was 0.763, in initial TnI level was 0.778; their combination AUC was 0.803. Conclusion: Increased TnI level at the early ICU admission was an independent risk factor for ICU mortality in non-cardiac surgery critically ill patients which had predictive value for death.