老年脓毒症患者胃镜下改良Lanza评分与预后的关系

Correlation between modified Lanza score under gastroscopy and prognosis of sepsis in geriatric patients

摘要:

目的 探讨老年脓毒症患者胃黏膜改良Lanza评分（modified Lanza score，MLS）对预后的评估价值。方法 回顾性分析2019年1月—2022年4月广东省人民医院老年重症医学科60岁以上且因疑似消化道出血而行胃镜检查的50例脓毒症患者的临床资料，按照胃镜检查后28 d内转归情况，分为死亡组（n=32）与存活组（n=18），采用MLS系统对患者胃黏膜进行评分，分析MLS≥1分患者病死率；并将患者分为MLS=0~2分（n=23，即病灶范围<2个胃域）与MLS=3~5分（n=27，即病灶范围≥2个胃域）两组，比较两组患者MLS与急性生理学及慢性健康状况（APACHE）Ⅱ评分、死亡风险系数及病死率的关系，分析MLS得分与病死率的相关性，采用logistic回归分析影响老年脓毒症患者28 d内预后的危险因素。结果 50例老年脓毒症患者中，伴有胃黏膜病变即MLS≥1分的患者占68.00%（34/50），其中死亡组中MLS≥1分的患者比例高于存活组中MLS≥1分的患者比例［84.38%（27/32）比38.89%（7/18），χ2=10.593，P<0.001］。MLS=3~5分组患者APACHE Ⅱ评分高于MLS=0~2分组［（26.09±6.47）分比（18.57±7.66）分，t=3.527，P=0.001］，且前者病死率高于后者［85.19%（23/27）比39.13%（9/23），χ2=11.434，P=0.001］。相关性分析显示，MLS得分与病死率显著相关（r=0.886，P=0.019）。多因素logistic回归分析显示MLS=4~5分是老年脓毒症患者死亡的独立危险因素（OR=17.055，95%CI：1.387~209.744，P=0.027）。结论 MLS用于老年脓毒症患者28 d内预后判断的敏感度较为理想，胃黏膜病变≥2个胃域显著增加老年脓毒症患者的死亡风险。

Abstract:

Objective To evaluate modified Lanza score (MLS) of gastric mucosa for predicting the prognosis of geriatric patients with sepsis. Methods Data of 50 patients with sepsis, who were over 60 years old and underwent gastroscopy for suspected gastrointestinal bleeding in the Department of Geriatric Critical Care Medicine of Guangdong Provincial People""s Hospital from January 2019 to April 2022, were retrospectively analyzed. Patients were divided into the death group (n=32) and the survival group (n=18) according to their regression within 28 days after gastroscopy. Their gastric mucosa was scored by using MLS system, and the mortality of patients with MLS≥1 was calculated, then the patients were further divided into 2 groups, MLS=0-2 (n=23, less than 2 regions of lesions ) and MLS=3-5 (n=27, two or more regions of lesions). The relationship between MLS and acute physiology and chronic health status evaluation (APACHE) Ⅱ score, risk factor of death and mortality in each group were compared. The correlation between MLS and mortality was analyzed. The influence of geriatric sepsis risk factors affecting the prognosis of patients within 28 days were analyzed by using logistic regression. Results Among the 50 geriatric patients with sepsis, those with gastric mucosal lesions, i.e., MLS ≥1, accounted for 68.00% (34/50), including 84.38% (27/32) patients with MLS≥1 in the death group, which was significantly higher than the 38.89% (7/18) patients with MLS≥1 in the survival group (χ2=10.593, P<0.001). Patients with MLS=3-5 had significantly higher APACHE Ⅱ scores (26.09±6.47 VS 18.57±7.66, t=3.527, P=0.001) and higher mortality [85.19% (23/27) VS 39.13% (9/23), χ2=11.434, P=0.001] compared with MLS=0-2. Correlation analysis showed a significant correlation between MLS and mortality (r=0.886, P=0.019). Multivariate logistic regression analysis showed that MLS=4-5 was an independent risk factor for death in geriatric patients with sepsis (OR=17.055, 95%CI: 1.387-209.744, P=0.027). Conclusion MLS presents high sensitivity in predicting 28-day outcomes for geriatric patients with sepsis. Two or more than 2 regions of gastric mucosal lesions can significantly increase the risk of death in geriatric patients with sepsis.