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目的探讨血浆中性粒细胞明胶蛋白酶相关脂质运载蛋白(NGAL)水平对严重脓毒症患者死亡和多器官功能障碍综合征(MODS)的预测价值。方法分析123例严重脓毒症和脓毒性休克患者血浆NGAL水平与发生MODS和死亡的相关性。结果 7d内47例发生MODS[第1天10例(8%),第7天37例(30%)]。12个月内发生死亡39例(32%)。高血浆NGAL水平组较低水平组出现MODS和死亡的风险更高(P<0.05)。ROC曲线分析显示,血浆NGAL水平对ICU内死亡病例有预测价值。Cox回归分析在校正混杂的危险因素后显示,血浆NGAL水平升高是死亡(HR=2.128,95%CI=1.078~4.203,P<0.05)和MODS(HR=1.896,95%CI=1.012~3.552,P<0.05)的独立预测因素。结论血浆NGAL水平升高是严重脓毒症患者MODS和死亡的独立预测因素。
Objective To investigate the predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) levels in patients with severe sepsis and multiple organ dysfunction syndrome (MODS). Methods The association between plasma NGAL level and occurrence of MODS and death in 123 patients with severe sepsis and septic shock was analyzed. RESULTS: MODS occurred in 47 patients within 7 days (10 cases on day 1 (8%) and 37 cases (30%) on day 7). Thirty-nine deaths occurred in 12 months (32%). Patients with high plasma NGAL levels had a lower risk of MODS and death (P <0.05). ROC curve analysis showed that plasma NGAL levels had predictive value for the deaths within the ICU. Cox regression analysis showed that the increase of plasma NGAL was death (HR = 2.128, 95% CI = 1.078-4.203, P <0.05) and MODS (HR = 1.896, 95% CI = 1.012-3.552 , P <0.05) independent predictors. Conclusions Elevated plasma levels of NGAL are independent predictors of MODS and death in patients with severe sepsis.