收稿日期: 2025-03-06
网络出版日期: 2025-07-02
基金资助
深圳市科技计划项目(KCXFZ2023073109410002);深圳市创伤救治临床研究中心项目(LCYSSQ20220823091 405012)
Predictive value of plasma fibrinogen for in⁃hospital mortality in patients with septic shock
Received date: 2025-03-06
Online published: 2025-07-02
目的 探讨脓毒性休克患者血浆纤维蛋白原（fibrinogen，FBG）水平与院内死亡的关系及其预测价值。 方法 回顾性分析2018年8月1日至2020年12月31日在深圳市第二人民医院ICU诊断为脓毒性休克的563例患者的临床资料。收集患者人口统计学信息，入院时的基本生命体征、血常规和生化指标，并计算急性生理学和慢性健康状况评估Ⅱ（acute physiology and chronic health evaluation Ⅱ， APACHEⅡ）评分。采用二元logistic回归分析探讨血浆FBG与脓毒性休克患者院内死亡的相关性，广义相加模型（generalized additive model， GAM）模型和平滑曲线拟合探讨非线性关系，分段式logistic线性回归进行量化。绘制FBG和APACHEⅡ评分对脓毒性休克患者院内死亡的受试者工作特征曲线（receiver operating characteristic， ROC），计算曲线下面积（area under curve，AUC），比较两者的预测效能。采用亚组分析来探讨不同人群的异质性。 结果 二元logistic回归分析提示血浆FBG与脓毒性休克患者院内死亡之间存在显著负相关（P < 0.05）。GAM模型和平滑曲线拟合确定脓毒性休克患者血浆FBG水平与院内死亡之间存在非线性关系，拐点为5.54 g/L。分段式线性回归模型提示拐点左侧（FBG ≤ 5.54 g/L），血浆FBG每降低1 g/L，死亡风险增加24.5%（OR = 0.755，P = 0.003）；而拐点右侧（FBG > 5.54 g/L），两者关系无统计学意义（OR = 1.049，P = 0.685）。亚组分析结果显示，各亚组特征对FBG与院内死亡之间的关系无修饰作用。 结论 脓毒性休克患者FBG水平与院内死亡之间存在非线性关系，对脓毒性休克患者院内死亡风险有一定的预测价值。
周力 , 韩勇 , 庞婷 , 雷景恒 , 曾珊 , 王静静 , 周岳杰 , 李舒雅 , 邓哲 . 血浆纤维蛋白原水平对脓毒性休克患者院内死亡的预测价值[J]. 实用医学杂志, 2025 , 41(12) : 1840 -1845 . DOI: 10.3969/j.issn.1006-5725.2025.12.010
Objective To explore the association between plasma fibrinogen （FBG） levels and the risk of in-hospital mortality among patients with septic shock. Methods The clinical data of 563 patients diagnosed with septic shock in the Intensive Care Unit （ICU） of Shenzhen Second People's Hospital from August 1， 2018， to December 31， 2020， were collected. Patient demographic information， basic vital signs， and blood routine and biochemical indices upon admission were gathered. Moreover， the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHEⅡ） scores were calculated. Binary logistic regression analysis was conducted to explore the correlation between plasma fibrinogen levels and in-hospital mortality in patients with septic shock. Additionally， a generalized additive model （GAM） and smoothed curve fitting were employed to investigate the nonlinear relationship between plasma fibrinogen and in-hospital mortality. Receiver operating characteristic （ROC） curves were constructed for FBG and APACHEⅡ scores to predict in-hospital mortality in septic shock patients. The area under the curve （AUC） was computed to compare the predictive efficacies of the two. Furthermore， a segmented linear regression model was utilized for quantification. Results Binary logistic regression analysis demonstrated a significant negative correlation between plasma fibrinogen levels and in-hospital mortality among patients with septic shock （P < 0.05）. GAM modeling and smoothed curve fitting disclosed a nonlinear association between plasma fibrinogen levels and in-hospital mortality， with an inflection point at 5.54 g/L. The segmented linear regression model indicated that， to the left of the inflection point （FBG ≤ 5.54 g/L）， for every 1 g/L decrease in plasma fibrinogen， the risk of death increased by 24.5% （OR = 0.755， P = 0.003）. Conversely， to the right of the inflection point （FBG > 5.54 g/L）， the relationship was not statistically significant （OR = 1.049， P = 0.685）. The findings of the subgroup analyses indicated that the characteristics of the subgroups did not alter the relationship between blood fibrinogen levels and in-hospital mortality. Conclusion There is a nonlinear relationship between FBG levels and in-hospital mortality in patients with septic shock， which has predictive value for evaluating the risk of in-hospital mortality in this patient cohort.
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