背景:有许多方法可用于预测经皮肾镜取石术后的脓毒症。本研究旨在比较快速序贯器官衰竭评估(qSOFA)的预测价值。全身炎症反应综合征(SISR),国家预警评分(新闻),白细胞介素-6(IL-6),和降钙素原(PCT)治疗败血症。
方法:接受经皮肾镜取石术的患者被纳入研究,并分为对照组和感染性休克组。qSOFA的有效性,SIRS,新闻,白细胞介素-6和降钙素原进行了评估,接收器工作特性曲线和曲线下面积用于比较这四个指标的预测准确性。
结果:在401名患者中,16例(3.99%)发生感染性休克。雌性,老年人,尿培养阳性和尿中亚硝酸盐阳性的患者更容易发生感染性休克。PCT,IL-6,SIRS,新闻,qSOFA,和手术时间被确定为感染性休克的独立危险因素。截止值如下:qSOFA评分>0.50,SIRS评分>2.50,NEWS评分>2.50,IL-6>264.00pg/ml。在通过IL-6鉴定为脓毒症的29名患者中,16个被证实发展为败血症。qSOFA确定了63例败血症病例,有16例确诊为败血症;新闻确定了122例败血症病例,其中14例实际上发生了败血症;SIRS确定了128例败血症患者,有16人被证实患有败血症。在预测能力方面,与qSOFA(AUC0.952,95%CI0.928~0.977)相比,IL-6(AUC0.993,95%CI0.985~1)具有更高的预测准确性,新闻(AUC0.824,95%CI0.720~0.929)和SIRS(AUC0.928,95%CI0.888~0.969)。
结论:与qSOFA相比,IL-6在预测PCNL后感染性休克方面具有更高的准确性,SIRS,和新闻。
BACKGROUND: There are numerous methods available for predicting sepsis following Percutaneous Nephrolithotomy. This study aims to compare the predictive value of Quick Sequential Organ Failure Assessment (
qSOFA), Systemic Inflammatory Response Syndrome (SISR), National Early Warning Score (NEWS), interleukin-6 (IL-6), and procalcitonin (PCT) for septicemia.
METHODS: Patients who underwent percutaneous nephrolithotomy were included in the study and divided into a control group and a septic shock group. The effectiveness of
qSOFA, SIRS, NEWS, Interleukin-6, and Procalcitonin was assessed, with Receiver Operating Characteristic curves and Area Under the Curve used to compare the predictive accuracy of these four indicators.
RESULTS: Among the 401 patients, 16 cases (3.99%) developed septic shock. Females, elderly individuals, and patients with positive urine culture and positive nitrite in urine were found to be more susceptible to septic shock. PCT, IL-6, SIRS, NEWS,
qSOFA, and surgical time were identified as independent risk factors for septic shock. The cutoff values are as follows:
qSOFA score > 0.50, SIRS score > 2.50, NEWS score > 2.50, and IL-6 > 264.00 pg/ml. Among the 29 patients identified by IL-6 as having sepsis, 16 were confirmed to have developed sepsis. The
qSOFA identified 63 septicemia cases, with 16 confirmed to have developed septicemia; NEWS identified 122 septicemia cases, of which 14 cases actually developed septicemia; SIRS identified 128 septicemia patients, with 16 confirmed to have developed septicemia. In terms of predictive ability, IL-6 (AUC 0.993, 95% CI 0.985 ~ 1) demonstrated a higher predictive accuracy compared to qSOFA (AUC 0.952, 95% CI 0.928 ~ 0.977), NEWS (AUC 0.824, 95% CI 0.720 ~ 0.929) and SIRS (AUC 0.928, 95% CI 0.888 ~ 0.969).
CONCLUSIONS: IL-6 has higher accuracy in predicting septic shock after PCNL compared to qSOFA, SIRS, and NEWS.