APACHE Ⅱ评分与NRBC含量对NRBC阳性ICU患者生存时间的预测价值

摘要

目的 探讨APACHE Ⅱ评分与有核红细胞(NRBC)含量对NRBC阳性ICU住院患者生存时间预测价值.方法 收集血常规检查中NRBC阳性的ICU住院患者67例.记录患者入住ICU 24h内的血小板分布宽度(PDW)、平均血小板体积(MPV)、血小板淋巴细胞比值(PLR)、NRBC、C反应蛋白(CRP)及前白蛋白/纤维蛋白原比值(PA/Fig)检测结果,同时跟踪并记录其诊疗过程及预后情况.根据随访结果将患者分为死亡组和生存组,其中死亡组17例,生存组50例,通过两组的临床资料与实验室结果比较,并进一步采用logistic回归分析筛选入选者死亡的危险因素,再采用Kaplan-meier法进行生存时间预测指标的探讨.结果 死亡组与生存组的Charlson合并症指数、APACHE Ⅱ评分、菌血症、脓毒血症、感染性休克、多重感染及机械通气等比较均有统计学差异(均P＜0.05).死亡组与生存组PDW、MPV、PLR、NRBC、CRP及PA/Fig的差异均有统计学意义(均P＜0.05).logistic回归分析结果显示APACHE Ⅱ评分及NRBC含量是NRBC阳性的ICU住院患者死亡的危险因素.Kaplan-meier法生存分析结果:将入选者按照APACHE Ⅱ评分及NRBC含量的中位数分为两组,APACHE Ⅱ评分≥29分与APACHE Ⅱ评分＜29分的生存时间有统计学差异(P=0.001);NRBC含量≥0.145×109/L及NRBC含量＜0.145×109/L的生存时间有统计学差异(P=0.018).结论 APACHE Ⅱ评分及NRBC含量是NRBC阳性的ICU住院患者死亡的危险因素,有助于预测生存时间.%Objective To investigate the application of APACHE Ⅱ score and nucleated red blood cell (NRBC) count in prediction of survival of NRBC positive patients in ICU.Methods Sixty seven patients with positive NRBC admitted in ICU from June 2015 to December 2015 were enrolled.Patients with hemorrhagic diseases and hematological diseases and those with NRBC not detected at admission were excluded in the study.The inflammation associated laboratory indexes within 24 h after admitted were recorded.During the study period 17 patients died (fatal group) and 50 survived (survival group).The clinical data and laboratory results were compared between the two groups,and logistic regression analysis was performed for risk factors and Kaplan-Meier method was used to analyze the predictors of survival time.Results There were significant differences in Charlson comorbidity index (CCI),APACHE Ⅱ score,proportion of bacteremia,proportion of sepsis,proportion of infection shock,proportion of multiple infection and proportion of mechanical ventilation between survival and fatal groups (P＜ 0.05).There were significant differences in laboratory indexes MPV,PLR,NRBC,CRP,PA/Fig and PDW between two groups (P＜0.05).The logistic regression analysis showed that APACHE Ⅱ score and NRBC were the independent risk factors for survival of NRBC positive ICU patients (OR=1.150,95％CI:1.015-1.302,P =0.028,(OR=20.933,95％CI:1.373-319.046,P =0.029).The Kaplan-Meier survival analysis showed that there was significant difference in the survival time between patients with APACHE Ⅱ score ≥29 and those ＜29,between patients with NRBC≥0.145 × 109/L and those＜0.145 × 109/L (P =0.001 and P =0.018).Conclusion APACHE Ⅱ score and NRBC were the risk factors for survival of NRBC positive patients in ICU.