摘要
目的 通过分析脓毒症患者新发心房颤动(房颤)的影响因素构建危险预测模型,为及早采取预防干预措施提供科学依据。方法 回顾性选取2020年1月-2024年4月承德医学院附属医院收治的脓毒症新发房颤者78例(新发房颤组)和未发生房颤者162例(无房颤组)为研究对象。统计分析两组一般情况、体温、平均动脉压、心率、呼吸频率、实验室指标及预后指标等,床旁超声评估左心收缩及舒张功能指标。比较两组患者上述资料差异,并采用多因素logistic回归分析脓毒症新发房颤的影响因素,并构建危险预测模型,绘制受试者工作特征曲线(ROC),评估相关指标的预测价值。结果 新发房颤组年龄、APACHE-Ⅱ评分、SOFA评分、血管活性药物剂量、28d病死率、凝血酶原时间(PT)、C-反应蛋白(CRP)、血乳酸(LAc)、肿瘤坏死因子-α(TNF-α)及E/e'高于无房颤组,PLT低于无房颤组,差异有统计学意义(均P<0.05);多因素logistic回归分析显示,年龄(OR=1.044,95%CI:1.012~1.077)、SOFA评分(OR=1.478,95%CI:1.245~1.753)、血管活性药物剂量(OR=1.761,95%CI:1.198~2.589)、TNF-α(OR=1.009,95%CI:1.002~1.015)及E/e'(OR=1.437,95%CI:1.076~1.920)是脓毒症新发房颤的独立危险因素(P<0.05);构建回归方程模型:logit(P)=-14.895+年龄×0.046+SOFA评分×0.372+血管活性药物剂量×0.557+TNF-α×0.008+E/e'×0.367。采用Hosmer-Lemeshow检验(χ^(2)=14.537,P=0.069),预测模型的曲线下面积(AUC)为0.894(95%CI:0.833~0.947)。ROC曲线分析显示,年龄、SOFA评分、血管活性药物剂量、TNF-α及E/e'对脓毒症新发房颤具有一定的预测价值,其AUC分别为0.643(95%CI:0.565~0.720)、0.815(95%CI:0.760~0.869)、0.885(95%CI:0.835~0.934)、0.686(95%CI:0.607~0.746)和0.694(95%CI:0.629~0.763)。结论 年龄、SOFA评分、血管活性药物剂量、TNF-α及E/e'为脓毒症新发房颤的独立危险因素,临床可进行早期预防和治疗,减少脓毒症新发房颤的发生。
Objective To analyze the risk factors of new-onset atrial fibrillation(AF)in patients with sepsis,and construct a risk prediction model to provide scientific basis for early preventive intervention.Methods A retrospective study was conducted from January 2020 to April 2024,78 patients with new-onset AF and 162 patients without were retrospectively analyzed.The general condition,body temperature,mean arterial pressure,heart rate,respiratory rate,laboratory and prognostic indicators were analyzed,and left ventricular systolic and diastolic functions were evaluated by bedside ultrasound between two groups.The above data were compared between two groups,and the influencing factors of new-onset atrial fibrillation were analyzed by multivariate logistic regression,and the risk prediction model was constructed.Receiver operating characteristic curve(ROC)was plotted to evaluate the predictive value of relevant indicators.Result Age,APACHE-Ⅱscore,SOFA score,vasoactive drug dose,28d mortality,PT,CRP,LAc,TNF-αand E/e'in new-onset AF group were significantly higher than those in non-AF group,and PLT was lower with statistical significance(P<0.05).Age(OR=1.044,95%CI:1.012-1.077),SOFA score(OR=1.478,95%CI:1.245-1.753),dose of vasoactive agent(OR=1.761,95%CI:1.198-2.589),TNF-α(OR=1.009,95%CI:1.002-1.015),and E/e'(OR=1.437,95%CI:1.076-1.920)were independent risk factors for new-onset AF in patients with sepsis(P<0.05).The risk prediction model was established:logit(P)=-14.895+age×0.046+SOFA score×0.372+vasoactive drug dose×0.557+TNF-α×0.008+E/e'×0.367.Hosmer-Lemeshow test was used(χ^(2)=14.537,P=0.069),and the AUC of the prediction model was 0.894(95%CI:0.833-0.947).ROC curve analysis showed that age,SOFA score,dose of vasoactive agent,TNF-αand E/e'had predictive value for newonset AF in patients with sepsis,and the AUC was 0.643(95%CI:0.565-0.720),0.815(95%CI:0.760-0.869),0.885(95%CI:0.835-0.934),0.686(95%CI:0.607-0.746)and 0.694(95%CI:0.629-0.763),respectively.Conclusions Age,SOFA score,vasoactive drug dose,TNF-αand E/e'are independent risk factors of new-onset AF in sepsis.Early prevention and treatment can be performed to reduce the occurrence of newonset AF in sepsis.
作者
夏嘉鼎
郭宇
张坤
徐敏
李国斌
郑欣
滑立伟
XIA Jiading;GUO Yu;ZHANG Kun;XU Min;LI Guobin;ZHENG Xin;HUA Liwei(Affiliated Hospital of Chengde Medical College,Chengde 067000,China)
出处
《中国煤炭工业医学杂志》
2024年第5期493-499,共7页
Chinese Journal of Coal Industry Medicine
基金
2022年度承德市科技计划项目(编号:202204A074)
2021年河北省政府资助临床医学优秀人才培养项目
关键词
脓毒症
心房颤动
新发
影响因素
Sepsis
Atrial fibrillation
New-onset
Influencing factors
