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| 血清生长分化因子-15水平与脓毒症机械通气患者并发重症监护病房获得性衰弱的相关性 |
| Correlation between serum growth differentiation factor-15 level and intensive care unit-acquired weakness in patients with sepsis requiring mechanical ventilation |
| 投稿时间：2023-03-21 |
| DOI：10.3969/j.issn.1000-0399.2023.12.002 |
| 中文关键词: 脓毒症 机械通气 生长分化因子-15 重症监护病房获得性衰弱 |
| 英文关键词: Sepsis Mechanical ventilation Growth differentiation factor-15 Intensive care unit-acquired weakness |
| 基金项目:海南省自然科学资金项目(编号:819MS128) |
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| 中文摘要: |
| 目的 探讨血清生长分化因子-15水平(GDF-15)与脓毒症机械通气患者并发重症监护病房获得性衰弱(ICU-AW的相关性,评估其是否可作为筛查ICU-AW的简易指标。方法 使用前瞻性观察研究方法,选取2021年1月至2023年1月海南医学院第二附属医院收治的308例脓毒症机械通气患者,依据是否并发ICU-AW分为ICU-AW组(n=96)和非ICU-AW组(n=212)。比较两组患者入院时一般资料、Charlson合并症指数(CCI)评分、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分以及入院时检测的血清降钙素原(PCT)、C-反应蛋白(CRP)、清蛋白、乳酸及GDF-15水平。采用Spearman相关分析法探讨脓毒症机械通气患者血清GDF-15水平与医学研究委员会(MRC)评分的相关性。对单因素分析差异具有统计学意义的变量进行多因素logistic回归分析以筛选影响脓毒症机械通气患者并发ICU-AW的独立危险因素。绘制受试者工作特征(ROC)曲线和决策曲线评估血清GDF-15水平对脓毒症机械通气患者并发ICU-AW的预测价值和临床实用性。结果 ICU-AW组和非ICU-AW组的平均MRC评分分别为(34.48±6.98)分和(55.35±3.65)分,差异有统计学意义(t=34.398,P<0.001)。ICU-AW组年龄、身体质量指数、CCI评分、APACHEⅡ评分、SOFA评分、脓毒性休克占比、机械通气持续时间以及血清乳酸、GDF-15水平高于或长于非ICU-AW组,血清清蛋白水平低于非ICU-AW组(P<0.05)。Spearman相关分析结果显示,脓毒症机械通气患者血清GDF-15水平与MRC评分呈显著负相关(rs=-0.645,P<0.001)。多因素logistic回归分析显示,年龄增长(OR=1.045,95%CI:1.004~1.087,P=0.033)、合并脓毒性休克(OR=2.268,95%CI:1.154~4.860,P<0.001)、较长的机械通气持续时间(OR=1.131,95%CI:1.015~1.261,P=0.026)和入院时血清GDF-15水平升高(OR=6.259,95%CI:3.812~10.275,P<0.001)是脓毒症机械通气患者并发ICU-AW的独立危险因素。经ROC曲线分析,血清GDF-15水平预测脓毒症机械通气患者并发ICU-AW的曲线下面积为0.867(95%CI:0.824~0.903),最佳截断值为2.16μg/L,灵敏度和特异度分别为87.50%和79.25%。经决策曲线分析,当高风险阈值为0.08~0.89时,血清GDF-15水平预测脓毒症机械通气患者并发ICU-AW具有临床获益优势。结论 并发ICU-AW的脓毒症机械通气患者入院时血清GDF-15水平明显升高,入院时血清GDF-15是脓毒症机械通气患者并发ICU-AW的危险因素,对脓毒症机械通气患者并发ICU-AW具有较高的预测价值和临床实用性。 |
| 英文摘要: |
| Objective To investigate the correlation between serum growth differentiation factor-15(GDF-15) level and concurrentintensive care unit-acquired weakness(ICU-AW) in patients with sepsis requiring mechanical ventilation(MV), and to determine a simple screening indicator for ICU-AW.Methods A prospective observational study was conducted. A total of 308 patients with sepsis requiring MV admitted to the Second Affiliated Hospital of Hainan Medical University from January 2021 to January 2023 were selected,and the patients were divided into ICU-AW group(n=96) and non-ICU-AW group(n=212) according to whether the complication of ICU-AWoccurred. Data at admission of patients between the two groups were compared, including the general data, Charlson's comorbidity index(CCI) score, acute physiology and chronic health evaluation II(APACHE II) score, sequential organ failure assessment(SOFA) score, and the serum levels of procalcitonin, C-reactive protein, albumin, lactic acid and GDF-15 detected at admission. Spearman correlation analysis was used to explore the correlation between serum GDF-15 level and Medical Research Council(MRC) score in patients with sepsis requiring MV. The multivariate logistic regression analysis was performed on the variables with statistically significant differences in univariate analysis to screen the independent risk factors for concurrent ICU-AW in patients with sepsis requiring MV. The receiver operating characteristic(ROC) curve and decision curve were drawn to evaluate the predictive value and clinical practicability of serum GDF-15 level for concurrent ICU-AW in patients with sepsis requiring MV.Results The average MRC scores of the ICU-AW group and the non-ICU-AW group were(34.48 ± 6.98) points and(55.35 ± 3.65) points, respectively, with a statistically significant difference(t=34.398, P<0.001). The age, body mass index, CCI score, APACHEⅡ score, SOFA score, the proportion of septic shock, the duration of MV, and the serum levels of lactic acid and GDF-15 of patients in the ICU-AW group were higher or longer than those in the non-ICU-AW group, while the serum albumin level of patients in the ICU-AW group was lower than that in the non-ICU-AW group(P<0.05). Spearman correlation analysis showed that the serum GDF-15 level hadsignificant negative correlation with the MRC score in patients with sepsis requiring MV(rs=-0.645, P<0.001). Multivariate logistic regression analysis showed that ageing(OR=1.045, 95%CI:1.04~1.087, P=0.033), septic shock(OR=2.268, 95%CI:1.154~4.860, P<0.001), prolonged duration of MV(OR=1.131, 95%CI:1.015~1.261, P=0.026) and the elevated serum level of GDF-15(OR=6.259, 95%CI:3.812~10.275, P<0.001) were independent risk factors for concurrent ICU-AW in patients with sepsis requiring MV. According to ROC curve analysis, the area under the curve of serum GDF-15 level for predicting concurrent ICU-AW in patients with sepsis requiring MV was 0.867(95%CI:0.824~0.903), with the optimal cut-off value of 2.16 μg/L, the sensitivity and specificity under the optimal cut-off value was 87.50% and 79.25%, respectively. According to the decision curve analysis, when the high risk threshold value was between 0.08 and 0.89, the serum GDF-15 level had a clinical benefit advantage for predicting concurrent ICU-AW in patients with sepsis requiring MV.Conclusions The serum levels of GDF-15 at admission in patients with sepsis requiring MV with ICU-AW obviously increase. And GDF-15 is a risk factor for concurrent ICU-AW in patients with sepsis requiring MV.Additionally, GDF-15 exhibits high predictive value and clinical practicality in identifying concurrent ICU-AW in patients with sepsis requiring MV. |
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