Value of peripheral perfusion index combined with APACHEⅡ score in predicting 28-day prognosis of patients with septic shock

doi:10.16138/j.1673-6087.2024.03.04

Abstract

Abstract:

Objective To study the value of peripheral perfusion index (PPI) combined with acute physiology and chronic evaluation Ⅱ(APACHEⅡ) score in predicting prognosis of septic shock patients. Methods A total of 200 patients diagnosed as septic shock in the emergency department of Xinjiang Medical University First Affiliated Hospital from January to August 2023 were prospectively included. The patients were divided into survival group (84 cases) and death group (116 cases) according to their 28-day prognosis. The patients’ information including name, age, gender, vital signs after admission, Glasgow coma scale(GCS), sepsis-related organ failure assessment(SOFA), APACHEⅡ, infection site, fluid intake within 24 h of admission, antibiotic use, past medical history, types and 24 h doses of vasopressors used, mechanical ventilation status, complete blood count, liver function, renal function, coagulation indicators, onset time, and 28-day prognosis outcomes were recorded. The lactate and PPI values of the two groups of patients were measured at the time of admission (0 h), 6 h after admission, and 12 h after admission, and the lactate clearance rate at 0-6 h and 0-12 h was calculated. Cox regression was used to screen independent factors for predicting the prognosis of septic shock patients, and the area under the ROC curve(AUC) was plotted. PPI parameter combined with APACHEⅡ score were analyzed in predicting AUC, which represented patients’ prognosis. Results Compared with the death group, the survival group had higher GCS score, 0 hPPI, 6 hPPI, 12 hPPI, 0-12 h lactic acid clearance rate, and lower in age, SOFA score, APACHEⅡ score, 0 h lactic acid, 12 h lactic acid (all P<0.05). COX regression showed that 12 hPPI was an independent predictor of the prognosis of patients with septic shock, and the AUC for predicting the prognosis of patients with septic shock was 0.945, and the 12 hPPI combined with APACHEⅡ score for predicting AUC as the prognosis of patients with was 0.996. Conclusions 12 hPPI combined with APACHEⅡ score after admission has good prognostic value for 28-day prognosis of patients with septic shock.

Key words: Peripheral perfusion index, Septic shock, APACHEⅡ score, Lactic acid clearance, Prognosis

CLC Number:

R631

GONG Hao, CHI Cheng, ZHANG Xiaoxia. Value of peripheral perfusion index combined with APACHEⅡ score in predicting 28-day prognosis of patients with septic shock[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(03): 174-179.

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References 23

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指标	存活组(n=84)	死亡组(n=116)	t/Z/χ²	P
年龄(岁)	57(49,69)	67(59,77)	-3.753	<0.001
男性[n(%)]	48(57.1)	76(65.5)	1.450	0.228
GCS(分)	15(5,15)	3(3,3)	-9.749	<0.001
SOFA(分)	6(4,8)	12(10,14)	-10.351	<0.001
APACHEⅡ(分)	19(16,24)	37(32,40)	-11.525	<0.001
体温(℃)	36(36,39)	36(36,38)	-0.806	0.420
脉搏(次/min)	126±41	114±42	1.823	0.358
MAP(mmHg)	61(51,65)	61(51,66)	-0.773	0.440
呼吸(次/min)	26±8	25±8	0.818	0.701
氧合指数(mmHg)	185±97	195±98	-0.692	0.927
白细胞(×10⁹/L)	11(7,16)	11(7,16)	-0.124	0.901
血红蛋白(g/L)	112±40	108±39	0.686	0.982
血小板(×10⁹/L)	165(125,244)	166(127,236)	-0.288	0.773
胆红素(μmol/L)	16(10,27)	16(11,27)	-0.067	0.947
ALT(>2 ULN)[n(%)]	7（17.5）	33（82.5）	12.320	<0.001
AST(>2 ULN)[n(%)]	8(11.4)	62(88.6)	41.318	<0.001
肌酐(μmol/L)	100(65,255)	99(69,252)	-0.203	0.839
白介素-6(ng/L)	104(30,1 878)	102(38,1 507)	-0.188	0.851
降钙素原(μg/L)	1.5(0.3,11.8)	1.0(0.2,9.3)	-0.594	0.552
24 h补液量(mL)	3 386±1 914	4 895±2 090	-5.218	<0.001
24 h去甲肾上腺素剂量(mL)	0(0,50)	100(50,200)	-7.774	<0.001
24 h多巴酚丁胺剂量(mL)	0.5±5.4	4.3±14.0	-2.584	<0.001
24 h多巴胺剂量(mL)	0(0,50)	50(0,100)	-4.928	<0.001
PT(s)	13(11,15)	14(12,21)	-4.017	<0.001
APTT(s)	28±3	33±6	-7.303	<0.001
D-二聚体(μg/L)	1 076(471,3 427)	1 159(262,5 588)	-0.498	0.619
感染部位[n(%)]			0.141	0.932
肺部	59(70.2)	81(69.8)
腹盆腔	16(19.0)	24(20.7)
其他(颅内、肠道、透析管路、足部)	9(10.7)	11(9.5)
发病时间(h)	8(2,48)	5(0,20)	-3.442	<0.001
机械通气[n(%)]	21(25.0)	91(78.4)	56.485	<0.001

抗菌药物	存活组(n=84)	死亡组(n=116)	χ²	P
碳青霉烯类	32(48.5)	66(63.5)	6.892	0.009
头孢类	29(43.9)	26(25.0)	3.584	0.058
喹诺酮类	5(7.6)	12(11.5)	1.209	0.272
联合用药	9(12.0)	5(4.6)	3.069	0.080

血管活性药物	存活组(n=84)	死亡组(n=116)	χ²	P
去甲肾上腺素	25(52.1)	89(50.3)	43.839	<0.001
多巴酚丁胺	1(2.1)	10(5.6)	3.844	0.05
多巴胺	22(45.8)	78(44.1)	32.841	<0.001

指标	存活组(n=84)	死亡组(n=116)	Z	P
0 h乳酸(mmol/L)	2.30(2.00,4.40)	4.15(3.03,6.40)	-6.278	<0.001
6 h乳酸(mmol/L)	1.50(1.20，2.30)	4.15(2.70，7.25)	-7.946	<0.001
12 h乳酸(mmol/L)	1.20(1.00,1.98)	2.95(2.20,6.20)	-7.835	<0.001
0 hPPI	0.84(0.60,1.74)	0.44(0.27,0.82)	-4.996	<0.001
6 hPPI	1.92(0.87,2.62)	0.76(0.42,1.35)	-7.298	<0.001
12 hPPI	3.24(2.22,4.08)	0.92(0.46,1.53)	-10.272	<0.001
0~6 h乳酸清除率（%）	38.10(18.44,54.37)	15.84(-34.00,38.62)	-4.926	<0.001
0~12 h乳酸清除率（%）	91.29(62.96,142.86)	40.37(-27.12,118.59)	-4.450	<0.001

指标	β	SE	Wald	HR	95%CI	P
年龄	0.017	0.006	9.485	1.017	1.006~1.029	0.002
SOFA	0.248	0.025	94.654	1.281	1.219~1.347	<0.001
APACHE Ⅱ	0.106	0.010	107.473	1.112	1.090~1.134	<0.001
24 h补液量	0.000	0.000	36.181	1.000	1.000~1.000	<0.001
24 h去甲肾上腺素剂量	0.007	0.001	65.880	1.007	1.005~1.009	<0.001
24 h多巴酚丁胺剂量	0.013	0.007	3.567	1.013	1.000~1.026	0.059
24 h多巴胺剂量	0.005	0.001	25.312	1.005	1.003~1.007	<0.001
0 h乳酸	0.082	0.023	12.436	1.085	1.037~1.136	<0.001
6 h乳酸	0.125	0.020	40.194	1.133	1.090~1.178	<0.001
12 h乳酸	0.160	0.021	60.350	1.174	1.127~1.222	<0.001
0 hPPI	-0.903	0.184	24.103	0.405	0.282~0.581	<0.001
6 hPPI	-0.921	0.139	44.193	0.398	0.303~0.522	<0.001
12 hPPI	-1.237	0.126	96.614	0.290	0.227~0.371	<0.001
0~12 h乳酸清除率	-0.003	0.001	9.103	0.997	0.995~0.999	0.003