qSOFA评分、血乳酸及红细胞分布宽度与急性上消化道出血病情严重程度的关系及其预测患者预后的效能分析

摘要 目的：探讨快速序贯器官功能衰竭评估（qSOFA）评分、血乳酸（Lac）及红细胞分布宽度（RDW）与急性上消化道出血（AUGIB）病情严重程度的关系及其预测患者预后的效能。方法：选取2017年6月～2022年6月我院收治的230例AUGIB患者为研究对象，根据病情严重程度分为低危组44例、中危组140例、高危组36例、极高危组10例，且根据其入院28 d内生存情况分为死亡组（n=31）和存活组（n=199）。收集AUGIB患者临床资料，检测血Lac、RDW水平并计算qSOFA评分。采用多因素Logistic回归分析AUGIB患者预后不良的影响因素，受试者工作特征（ROC）曲线分析qSOFA评分和血Lac、RDW对AUGIB患者预后不良的预测价值。结果：低危组、中危组、高危组、极高危组qSOFA评分和血Lac、RDW水平依次升高（P＜0.05）。230例AUGIB患者入院28 d内死亡率为13.48％（31/230）。多因素Logistic回归分析显示，年龄增加、GBS评分≥6分及休克指数、qSOFA评分、血尿素氮、血Lac、RDW水平升高为AUGIB患者预后不良的独立危险因素（P＜0.05）。ROC曲线分析显示，qSOFA评分、血Lac及RDW联合预测AUGIB患者预后不良的曲线下面积大于qSOFA评分、血Lac及RDW单独预测。结论：AUGIB患者qSOFA评分、血Lac及RDW水平升高与病情加重和预后不良密切相关，qSOFA评分、血Lac及RDW联合预测AUGIB患者预后不良的效能较高。

Relationship between qSOFA Score, Blood Lactate and Red Blood Cell Distribution Width and Severity of Illness of Acute Upper Gastrointestinal Bleeding and Their Efficacy Analysis in Predicting Patient Prognosis

ABSTRACT Objective: To investigate the relationship between the quick Sequential Organ Failure Assessment (qSOFA) score, blood lactate (Lac) and red blood cell distribution width (RDW) and the severity of illness of acute upper gastrointestinal bleeding (AUGIB) and their efficacy in predicting patient prognosis. Methods: 230 patients with AUGIB who were admitted to our hospital from June 2017 to June 2022 were selected as the research objects. They were divided into low risk group with 44 cases, medium risk group with 140 cases, high risk group with 36 cases, and extremely high risk group with 10 cases according to the severity of the disease. They were also divided into death group (n=31) and survival group (n=199) according to their survival within 28 days after admission. The clinical data of patients with AUGIB were collected, the blood Lac and RDW levels were detected, and the qSOFA score was calculated. Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis of patients with AUGIB, and the predictive value of qSOFA score and blood Lac, RDW on poor prognosis of patients with AUGIB was analyzed by receiver operating characteristic (ROC) curve. Results: The qSOFA score, blood Lac and RDW levels in the low risk group, medium risk group, high risk group and extremely high risk group increased in turn (P<0.05). The mortality of 230 patients with AUGIB within 28 days after admission was 13.48%(31/230). Multivariate Logistic regression analysis showed that increased of age, GBS score greater than or equal to 6 scores, shock index, qSOFA score, blood urea nitrogen, blood Lac and RDW levels were independent risk factors for poor prognosis of patients with AUGIB(P<0.05). ROC curve analysis showed that the area under curve of qSOFA score, blood Lac and RDW combined to predict poor prognosis of patients with AUGIB was larger than that of qSOFA score, blood Lac and RDW alone. Conclusion: The increased of qSOFA score, blood Lac and RDW levels in patients with AUGIB is closely related to the aggravation of the disease and poor prognosis. The combination of qSOFA score, blood Lac and RDW has a higher efficacy in predicting the poor prognosis of patients with AUGIB.