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

doi:10.3969/j.issn.1006-5725.2025.12.010

Abstract

Abstract:

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.

Key words: septic shock, plasma fibrinogen, in-hospital mortality, non-linear relationship

CLC Number:

R441.9

Li ZHOU,Yong HAN,Ting PANG,Jingheng LEI,Shan ZENG,Jingjing WANG,Yuejie ZHOU,Shuya LI,Zhe DENG. Predictive value of plasma fibrinogen for in⁃hospital mortality in patients with septic shock[J]. The Journal of Practical Medicine, 2025, 41(12): 1840-1845.

Figures/Tables 9

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References 26

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项目	Q1（n = 140）	Q2（n = 137）	Q3（n = 145）	Q4（n = 141）	F/χ²/H值	P值
年龄（x ± s）/岁	68.31 ± 17.30	72.62 ± 15.98	72.21 ± 16.19	69.52 ± 16.22	2.262	0.080
性别/［例（%）］					2.275	0.079
男	73（52.14）	92（67.15）	88（60.69）	81（57.45）
女	67（47.86）	45（32.85）	57（39.31）	60（42.55）
糖尿病/［例（%）］	37（26.43）	42（30.66）	59（40.69）	54（38.30）	2.787	0.040
体温（x ± s）/℃	36.74 ± 0.99	36.86 ± 0.75	37.03 ± 1.01	36.99 ± 0.85	2.964	0.032
呼吸频率（x ± s）/（次/min）	21.80 ± 6.29	21.53 ± 6.53	23.37 ± 7.97	22.95 ± 6.88	2.286	0.034
血浆FBG（x ± s）/（g/L）	2.32 ± 0.51	3.64 ± 0.31	4.90 ± 0.45	7.16 ± 1.16	125.005	< 0.001
D-D/（mg/L）	6.79（2.73，14.93）	5.39（2.15，10.46）	4.48（2.10，8.16）	4.94（2.04，9.13）	2.974	0.025
血乳酸/（mmol/L）	3.20（2.00，5.11）	2.40（1.60，3.50）	2.20（1.60，3.20）	2.10（1.60，3.20）	7.330	< 0.001
CRP/（mg/L）	51.66（18.64，102.11）	90.33（46.02，151.94）	119.41（73.65，190.21）	184.55（115.53，248.84）	56.846	< 0.001
PLT/（×10⁹/L）	133.00（71.50，199.00）	149.00（94.00，217.00）	166.00（113.00，254.00）	192.00（123.00，251.00）	6.214	< 0.001
APACHEⅡ（x ± s）/分	27.90 ± 8.49	25.82 ± 8.45	25.65 ± 9.35	25.45 ± 9.58	2.250	0.017

影响因素	未调整模型		模型Ⅰ		模型Ⅱ
影响因素	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值
FBG	0.860（0.787 ~ 0.941）	< 0.001	0.855（0.781 ~ 0.936）	< 0.001	0.862（0.765 ~ 0.972）	0.015
FBG四分组
Q1（< 3.10 g/L）	Ref		Ref		Ref
Q2（3.10 ~ 4.21 g/L）	1.086（0.673 ~ 1.753）	0.736	0.978（0.599 ~ 1.595）	0.928	1.121（0.660 ~ 1.903）	0.673
Q3（4.22 ~ 5.75 g/L）	0.529（0.330 ~ 0.847）	0.008	0.476（0.294 ~ 0.770）	0.003	0.542（0.311 ~ 0.944）	0.031
Q4（> 5.75 g/L）	0.555（0.346 ~ 0.891）	0.015	0.530（0.328 ~ 0.857）	0.009	0.584（0.317 ~ 1.079）	0.086

影响因素	GAM模型
影响因素	OR（95%CI）	P值
FBG	0.861（0.760 ~ 0.975）	0.019
FBG四分组
Q1（< 3.10 g/L）	Ref
Q2（3.10 ~ 4.21 g/L）	1.055（0.610 ~ 1.827）	0.848
Q3（4.22 ~ 5.75 g/L）	0.487（0.272 ~ 0.871）	0.015
Q4（> 5.75 g/L）	0.533（0.281， 1.009）	0.053

院内死亡	OR（95%CI）	P值
两分段式线性回归模型
血浆FBG的拐点	5.54 g/L
≤ 5.54 g/L	0.755（0.629 ~ 0.906）	< 0.01
> 5.54 g/L	1.049（0.831 ~ 1.325）	0.685

指标	AUC值	95%CI	最佳阈值	特异度/%	敏感度/%
FBG	0.689	0.642 ~ 0.736	4.3000	56.83	60.70
APACHEⅡ	0.759	0.713 ~ 0.805	26.4947	64.03	58.25

Predictive value of plasma fibrinogen for in⁃hospital mortality in patients with septic shock

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指标	样本量	OR（95%CI）	P值
年龄			0.056 8
< 60岁	125	0.836（0.683 ~ 1.022）
60 ~ 70岁	86	0.754（0.564 ~ 1.009）
70 ~ 80岁	149	0.736（0.592 ~ 0.914）
≥ 80岁	203	1.019（0.851 ~ 1.219）
性别			0.741 7
男	334	1.059（0.984 ~ 1.139）
女	229	1.075（0.999 ~ 1.158）
高血压病史	318	0.839（0.728 ~ 0.966）	0.465 2
糖尿病史	192	0.858（0.717 ~ 1.026）	0.941 9
慢性阻塞性肺疾病史	108	0.773（0.618 ~ 0.968）	0.252 3
吸烟状况			0.673 1
正在吸烟	58	0.940（0.674 ~ 1.311）
已戒烟	34	0.990（0.644 ~ 1.524）
酗酒状况			0.751 9
正在酗酒	25	0.992（0.561 ~ 1.753）
曾经酗酒	25	0.729（0.406 ~ 1.308）

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