Crit Care:早期肌钙蛋白I在危重病中的作用及其与住院死亡率的相关性

2017-08-20 MedSci MedSci原创

对于危重症患者通常会频繁的监测肌钙蛋白I(TnI),然而其作用并不十分明确。本研究的首要目标为评估TnI是否与住院死亡率有关,以及调整潜在的混杂因素后这种关联是否继续存在。我们还旨在于确定急性生理和慢性健康状况评分Ⅱ(APACHE Ⅱ)加上TNI这种风险预测模型,从而可以提高监测TnI在重症监护病房(ICU)的可行性。

对于危重症患者通常会频繁的监测肌钙蛋白I(TnI),然而其作用并不十分明确。本研究的首要目标为评估TnI是否与住院死亡率有关,以及调整潜在的混杂因素后这种关联是否继续存在。我们还旨在于确定急性生理和慢性健康状况评分Ⅱ(APACHE Ⅱ)加上TNI这种风险预测模型,从而可以提高监测TnI在重症监护病房(ICU)的可行性。

我们对英国两个3级医疗中心的ICU进行了独立的推导和验证观察性队列研究。推导队列是2010-2014年间收住普通ICU的患者(N=1349),验证队列对2010间的资料组进行前瞻性研究的二次分析(N=145)。主要暴露情况为入住ICU 24小时内采取血样本测量血浆TnI浓度,主要结果为住院期间死亡率。我们采用多元回归分析APACHE Ⅱ评分模型的参数,在多元变量模型中推导出TnI的风险预测评分。

结果显示,相比在住院期间未检测到TnI升高的患者14.6%(n=102)来说,检测到TnI升高患者的死亡率为37.3%(n = 242)。TnI与住院死亡率之间有显著的单变量关联(TnI每增加1倍 OR 1.16,95% CI 1.13-1.20,P<0.001)。对APACHE Ⅱ模型参数调整后此关联依然存在(TnI OR 1.05,95% CI 1.01-1.09,P=0.003)。TnI与APACHE Ⅱ评分中的急性生理学评分(APS)显著相关(R=0.39)。APACHE Ⅱ模型联合TnI并不能改善差异(APACHE Ⅱ一致性统计【c-指数】0.835,95% CI 0.811-0.858;APACHEⅡTnI c-指数0.837,95% CI 0.813-0.860;P=0.330)。

所以我们可以得出结论,TnI是住院死亡率的独立预测因子,与APACHEⅡ的APS评分显着相关。TnI不提高风险预测,所以我们不主张对入ICU的患者采用常规的肌钙蛋白分析,我们建议只有在临床确诊后可对肌钙蛋白进行监测。

原始出处:

Docherty AB1,2, Sim M3, et al. Early troponin I in critical illness and its association with hospital mortality: a cohort study. Crit Care. 2017 Aug 16;21(1):216. doi: 10.1186/s13054-017-1800-4.

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    2017-08-20 有备才能无患

    TnI是住院死亡率的独立预测因子,与APACHEⅡ的APS评分显着相关。TnI不提高风险预测,所以我们不主张对入ICU的患者采用常规的肌钙蛋白分析,我们建议只有在临床确诊后可对肌钙蛋白进行监测。

    0

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    2017-08-20 131****1460

    学习了受益匪浅。

    0

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    2017-08-20 1e0f8808m18(暂无匿称)

    肌上七汉夕,互相显著相关

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1690449, encodeId=d6ad16904494f, content=<a href='/topic/show?id=fdb336e49bb' target=_blank style='color:#2F92EE;'>#危重病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36749, encryptionId=fdb336e49bb, topicName=危重病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=27f729051889, createdName=xinmeili, createdTime=Wed Jan 31 01:41:00 CST 2018, time=2018-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1837324, encodeId=1d26183e3249f, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Fri Apr 06 15:41:00 CST 2018, time=2018-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366157, encodeId=cec4136615e85, content=<a href='/topic/show?id=7d2f26450be' target=_blank style='color:#2F92EE;'>#住院死亡率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26450, encryptionId=7d2f26450be, topicName=住院死亡率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db7c233, createdName=changjitao2009, createdTime=Tue Aug 22 01:41:00 CST 2017, time=2017-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576039, encodeId=0f8e15e6039d9, content=<a href='/topic/show?id=10f7810863d' target=_blank style='color:#2F92EE;'>#肌钙蛋白I#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81086, encryptionId=10f7810863d, topicName=肌钙蛋白I)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=44d016291895, createdName=sunrural_42825362, createdTime=Tue Aug 22 01:41:00 CST 2017, time=2017-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=235501, encodeId=517623550104, content=TnI是住院死亡率的独立预测因子,与APACHEⅡ的APS评分显着相关。TnI不提高风险预测,所以我们不主张对入ICU的患者采用常规的肌钙蛋白分析,我们建议只有在临床确诊后可对肌钙蛋白进行监测。, beContent=null, objectType=article, channel=null, level=null, likeNumber=2, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sun Aug 20 23:19:19 CST 2017, time=2017-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=235443, encodeId=83c123544324, content=学习了受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sun Aug 20 16:36:47 CST 2017, time=2017-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=235417, encodeId=361623541e9d, content=肌上七汉夕,互相显著相关, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sun Aug 20 14:46:29 CST 2017, time=2017-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=235397, encodeId=18a523539ebd, content=学习了,谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sun Aug 20 13:36:31 CST 2017, time=2017-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=235390, encodeId=3cdb23539010, content=学习了,涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Aug 20 12:59:42 CST 2017, time=2017-08-20, status=1, ipAttribution=)]
    2017-08-20 惠映实验室

    学习了,谢谢。

    0

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    2017-08-20 1ddf0692m34(暂无匿称)

    学习了,涨知识

    0

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