摘要目的 探讨血钙水平对脓毒症患者预后的影响.方法 回顾性分析2017年1月至2018年10月中国科学技术大学附属第一医院重症医学科(ICU)收治的119例脓毒症患者的临床资料,收集患者的性别、年龄和确诊24 h内C-反应蛋白(CRP)、降钙素原(PCT)、血钙水平、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)以及28 d病死率.根据血钙水平将患者分成正常血钙组(血钙2.00～2.67 mmol/L)及低钙血症组(血钙＜2.00 mmol/L),另外根据28 d预后将患者分为存活组和死亡组,比较组间各指标的差异;采用Pearson相关性检验分析血钙水平与临床各指标间的相关性;采用受试者工作特征曲线(ROC)分析血钙水平对脓毒症预后的预测价值.结果 119例脓毒症患者中,血钙正常50例,血钙水平为(2.14±0.10)mmol/L ;低钙血症69例,低钙血症发生率为57.98%,血钙水平为(1.81±0.14)mmol/L.低钙血症组除APACHEⅡ评分明显高于正常血钙组外(分:25.59±5.52比22.28±4.89,P＜0.01),两组性别、年龄、CRP、PCT及SOFA评分差异均无统计学意义.低钙血症组28 d病死率显著高于正常血钙组〔78.26%(54/69)比48.00%(24/50),χ2＝10.45,P＜0.01〕.死亡组血钙水平明显低于存活组(mmol/L:1.90±0.20比2.04±0.19),而APACHEⅡ评分明显高于存活组(分:25.78±5.25比21.20±4.68),差异均有统计学意义(均P＜0.01).脓毒症患者血钙水平与PCT、APACHEⅡ评分呈负相关(r1＝-2.10、P1＝0.04,r2＝-3.91、P2＜0.01),而与CRP、SOFA评分无相关性(r1＝0.75、P1＝ 0.46,r2＝-1.21、P2＝0.23).ROC曲线分析显示,血钙水平预测脓毒症患者预后的ROC曲线下面积(AUC)为0.70 〔95%可信区间(95%CI)＝0.602～0.798〕,最佳阈值为1.92 mmol/L时,其敏感度为52.56%,特异度为82.93%.结论 脓毒症患者合并低钙血症时预后较差;血钙水平可作为判断脓毒症患者预后的指标.

abstractsObjective To investigate the effect of serum calcium level on the prognosis of patients with sepsis. Methods Clinical data of 119 patients with sepsis admitted to intensive care medicine (ICU) of the First Affiliated Hospital of the University of Science and Technology of China from January 2017 to October 2018 were retrospectively analyzed. Gender, age, and C-reactive protein (CRP), procalcitonin (PCT), serum calcium levels, acute physiology and chronic health evaluationⅡ(APACHEⅡ), sequential organ failure score (SOFA) within 24 hours of diagnosis, and 28-day mortality were collected. The patients were divided into the normal serum calcium group (serum calcium 2.00-2.67 mmol/L) and the hypocalcemia group (serum calcium < 2.00 mmol/L) according to their serum calcium level. The patients were divided into survival group and death group according to 28-day prognosis. Pearson correlation test was used to analyze the correlation between serum calcium level and clinical indicators. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum calcium level on prognosis. Results A total of 119 patients with sepsis were included, including 50 patients with normal serum calcium, with serum calcium level of (2.14±0.10) mmol/L; and 69 patients of hypocalcemia, and the incidence of hypocalcemia was 57.98%, with serum calcium level of (1.81±0.14) mmol/L. In the hypocalcemia group, except that the APACHEⅡ score was significantly higher than that of the normal serum calcium group (25.59±5.52 vs. 22.28±4.89, P < 0.01), there was no significant difference in gender, age, CRP, PCT and SOFA score between the two groups. The 28-day mortality rate of the hypocalcemia group was significantly higher than that of the normal serum calcium group [78.26% (54/69) vs. 48.00% (24/50), χ2 = 10.45, P < 0.01]. The level of serum calcium in the death group was significantly lower than that in the survival group (mmol/L: 1.90±0.20 vs. 2.04±0.19), while the APACHEⅡ score was significantly higher than the survival group (25.78±5.25 vs. 21.20±4.68), with statistically significant differences (both P < 0.01). There was a negative correlation between serum calcium level and PCT, APACHEⅡ scores in patients with sepsis (r1 = -2.10, P1 = 0.04;r2 = -3.91, P2 < 0.01), but no correlation with CRP and SOFA score (r1 = 0.75, P1 = 0.46; r2 = -1.21, P2 = 0.23). The ROC curve analysis showed that the area under the ROC curve (AUC) for predicting the prognosis of sepsis patients with serum calcium level was 0.70 [95% confidence interval (95%CI) = 0.602-0.798], and the best cut-off value was 1.92 mmol/L, with the sensitivity was 52.56%, and the specificity was 82.93%. Conclusions The prognosis of sepsis patients with hypocalcemia is poor. Serum calcium level can be used as a predictor of prognosis in patients with sepsis.