全心舒张末期容积指数及血管外肺水指数在老年心力衰竭合并脓毒性休克患者预后中的预测价值

李欢; 王帅; 李楠

doi:10.12125/j.chj.202101007

全心舒张末期容积指数及血管外肺水指数在老年心力衰竭合并脓毒性休克患者预后中的预测价值

Predictive value of global end-diastolic volume index and extravascular lung water index in prognosis of elderly patients with heart failure and septic shock

摘要

摘要:
目的分析全心舒张末期容积指数（GEDI）及血管外肺水指数（ELWI）在老年心力衰竭（HF）合并脓毒性休克患者中的变化情况，探究其对预后预测价值。
方法选取海军第971医院2017年1月～2020年5月老年HF合并脓毒性休克患者87例，根据住院期间生存状况分为生存组（66例）与死亡组（21例）。比较两组一般资料、液体复苏前后GEDI与ELWI、急性生理与慢性健康评价系统Ⅱ（APACHEⅡ）、序贯脏器衰竭（SOFA）评分，采用Perason相关性分析GEDI、ELWI与APACHEⅡ、SOFA评分关联性，Logistic回归分析老年HF合并脓毒性休克患者预后相关因素，受试者工作特征（ROC）曲线评价GEDI、ELWI对预后的预测价值。
结果两组年龄、心功能分级、合并急性呼吸窘迫综合征（ARDS）差异有统计学意义（P<0.05）；生存组液体复苏后6 h、24 h APACHEⅡ、SOFA评分、ELWI较液体复苏前降低，且显著低于死亡组，GEDI较液体复苏前升高，且显著高于死亡组（P<0.05）；Pearson相关性分析，液体复苏后6 h、24 h GEDI与APACHEⅡ、SOFA评分呈负相关，液体复苏后6 h、24 h ELWI与APACHEⅡ、SOFA评分呈正相关（P<0.05）；Logistic回归分析，年龄、心功能分级、合并ARDS、液体复苏后6 h、24 h GEDI、ELWI是老年HF合并脓毒性休克患者预后的重要影响因素（P<0.05）；ROC曲线分析，液体复苏后6 h、24 h GEDI、ELWI联合预测预后AUC分别为0.853（95%CI为0.761~0.920）、0.885（0.798~0.943），敏感度分别为71%、81%，特异度分别为82%、86%，优于同时间点两者单独预测（P<0.05）。
结论 GEDI与ELWI可作为老年HF合并脓毒性休克患者评估病情变化与预测预后的敏感因子。

Abstract:
AIM To analyze the changes of global end-diastolic volume index (GEDI) and extravascular lung water index (ELWI) in elderly patients with heart failure (HF) combined with septic shock, explore their prognostic value and provide relevant evidence for clinical early prediction of prognosis and adjustment of treatment regimens.
METHODS From January 2017 to May 2020, 87 elderly patients with HF and septic shock in our hospital were selected and divided into survival group (66 cases) and death group (21 cases) according to their survival status during hospitalization. The general data, GEDI, ELWI, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE II) scores and Sequential Organ Failure Assessment (SOFA) scores before and after fluid resuscitation were compared between the two groups. Perason correlation was used to analyze the correlation between GEDI, ELWI and APACHE Ⅱ scores, SOFA scores. Logistic regression analysis was used to analyze the prognostic factors of elderly patients with HF and septic shock. The receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of GEDI and ELWI.
RESULTS There were statistically significant differences in age, cardiac function classification and ARDS between the two groups (P<0.05). APACHE Ⅱ scores, SOFA scores and ELWI in survival group were lower than those before fluid resuscitation at 6h and 24h after fluid resuscitation, and were lower than those in death group, and GEDI was higher than that before fluid resuscitation and was higher than that in death group (P<0.05). Pearson correlation analysis showed that GEDI at 6h and 24h after fluid resuscitation was negatively correlated with APACHE II and SOFA scores, and at 6h and 24h after fluid resuscitation, ELWI was positively correlated with APACHE II and SOFA scores (P<0.05). Logistic regression analysis showed that age, cardiac function classification, combined ARDS, GEDI and ELWI at 6h and 24h after fluid resuscitation were important factors affecting the prognosis of elderly patients with HF and septic shock (P<0.05). ROC curve analysis showed that at 6h and 24h after fluid resuscitation, the AUC of prognosis predicted by GEDI and ELWI was 0.853 (95% CI 0.761～0.920) and 0.885 (0.798～0.943), the sensitivity was 71% and 81%, and the specificity was 82% and 86%, which were better than the prediction by either of them alone at the same time point (P<0.05).
CONCLUSION GEDI and ELWI can be used as sensitive factors to assess changes of patients’ condition and to predict the prognosis of elderly patients with HF and septic shock.

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