2022 年第 2 期 第 17 卷

重症社区获得性肺炎患者红细胞输注的危险因素及序贯器官衰竭评估联合总铁结合力对其的预测价值

Risk factors and the predictive value of sequential organ failure assessment combined with total iron binding capacity for red blood cell transfusion in patients with severe community-acquired pneumonia

作者：吴少芳侯亚南吴兰香

英文作者：Wu Shaofang Hou Yanan Wu Lanxiang

单位：海南医学院第二附属医院呼吸内科，海口570311

英文单位：Department of Respiratory Medicine the Second Affiliated Hospital of Hainan Medical University Haikou 570311 China

关键词：重症社区获得性肺炎；序贯器官衰竭评估；总铁结合力；红细胞输注

英文关键词：Severecommunity-acquiredpneumonia;Sequentialorganfailureassessment;Totalironbindingcapacity;Redbloodcelltransfusion 

• 摘要：

• 目的  探讨重症社区获得性肺炎（SCAP）患者红细胞输注的危险因素及序贯器官衰竭评估(SOFA)联合总铁结合力（TIBC）对红细胞输注的预测价值。方法  选取2020年1月至2021年3月海南医学院第二附属医院重症监护病房（ICU）收治的116例SCAP患者作为研究对象，根据患者入住ICU 7 d内是否输注红细胞分为红细胞输注组（观察组，50例）和无红细胞输注组（对照组，66例）。比较2组患者的一般资料及实验室检查指标，采用多因素Logistic 回归模型分析SCAP患者红细胞输注的危险因素，受试者工作特征(ROC)曲线评估SOFA评分、TIBC及二者联合对红细胞输注的预测价值。结果  观察组SOFA评分、累计失血量、28 d病死率及铁蛋白水平均高于对照组，机械通气时间、ICU停留时间均长于对照组，白蛋白、TIBC、转铁蛋白及血红蛋白水平均低于对照组，差异均有统计学意义(均P＜0.05)。多因素Logistic回归分析结果显示，SOFA评分（比值比=1.411，95%置信区间：1.109～1.796，P=0.005）、累计失血量（比值比=1.009，95%置信区间：1.004～1.015，P=0.001）为SCAP患者红细胞输注的独立危险因素，TIBC（比值比=0.976，95%置信区间：0.961～0.992，P=0.003）为独立保护因素。ROC曲线分析结果显示，SOFA评分与TIBC联合预测SCAP患者红细胞输注的曲线下面积大于二者单独预测（均P<0.05）。结论  SOFA评分和TIBC与SCAP患者红细胞输注的发生密切相关，二者联合对红细胞输注具有较高的预测效能。

• Objective To explore the risk factors of red blood cell (RBC) transfusion in patients with severe community-acquired pneumonia (SCAP) and the predictive value of sequential organ failure assessment (SOFA) combined with total iron binding capacity（TIBC） in RBC transfusion. Methods From January 2020 to March 2021, 116 patients with SCAP admitted to intensive care unit（ICU）, the Second Affiliated Hospital of Hainan Medical University were selected. They were divided into RBC transfusion group (observation group, 50 cases) and non-RBC transfusion group (control group, 66 cases) according to whether RBC were transfused or not within 7 d. General data and laboratory indicators were compared between the two groups. Multivariate Logistic regression analysis was used to analyze the risk factors for RBC transfusion in SCAP patients. The receiver operating characteristics (ROC) curve was used to analyze the predictive value of SOFA score, TIBC and combination of the two indexes in RBC transfusion. Results The SOFA score, cumulative blood loss, 28 d mortality and ferritin level in observation group were higher than those in control group，the mechanical ventilation time and length of ICU stay in observation group were longer than those in control group, and levels of albumin, transferrin, TIBC and hemoglobin in observation group were lower than those in control group(all P＜0.05). Multivariate Logistic regression analysis showed that SOFA score（odds ratio=1.411, 95% confidence interval: 1.109-1.796, P=0.005） and cumulative blood loss（odds ratio=1.009, 95% confidence interval: 1.004-1.015, P=0.001） were independent risk factors for RBC transfusion in SCAP patients, and TIBC was an independent protective factor（odds ratio=0.976, 95% confidence interval: 0.961-0.992, P=0.003）. ROC curve analysis showed that the area under the curve for predicting RBC transfusion by SOFA score combined with TIBC was larger than those alone（both P<0.05）. Conclusions OFA score and TIBC are closely related to the occurrence of RBC transfusion in SCAP patients, and those combination has greater predictive value to RBC transfusion.