Abstract:

Objective　To explore the value of serum total bilirubin (TBil), D-dimer, and interleukin-6 (IL-6) in the assessment of condition and prognosis of elderly patients with sepsis. Methods　The clinical data of 166 elderly patients with sepsis admitted to Huangshi Central Hospital from January 2019 to January 2022 were retrospectively analyzed, including 97 males and 69 females, with an age of (75.5±4.0) years old. They were divided into a sepsis group (134 cases) and a septic shock group (32 cases) according to the conditions, and were divided into a survival group (119 cases) and a death group (47 cases) according to the prognosis after 28 days of treatment. The levels of serum TBil, D-dimer, and IL-6 in patients with different conditions and prognosis were compared. Spearman correlation analysis was used to analyze the correlations between serum TBil, D-dimer, and IL-6 levels and the condition of elderly patients with sepsis, and the receiver operating characteristic curve (ROC) was used to analyze the values of serum TBil, D-dimer, and IL-6 levels in evaluating the prognosis of elderly patients with sepsis. The measurement data were analyzed by independent sample t test. Results　The serum levels of TBil, D-dimer, and IL-6 in the septic shock group were (26.90±4.37) μmol/L, (4.86±1.14) mg/L, and (276.25±24.33) pg/ml, which were significantly higher than those in the sepsis group [(19.85±3.83) μmol/L, (2.10±0.89) mg/L, and (212.66±22.79) pg/ml], with statistically significant differences (all P<0.05). The serum levels of TBil, D-dimer, and IL-6 in the death group were (24.15±4.09) μmol/L, (3.66±1.05) mg/L, and (245.33±22.72) pg/ml, which were significantly higher than those in the survival group [(20.05±3.56) μmol/L, (2.23±0.67) mg/L, and (221.36±20.91) pg/ml], with statistically significant differences (all P<0.05). Spearman correlation analysis showed that serum TBil, D-dimer, and IL-6 levels were significantly positively correlated with the condition of elderly patients with sepsis (r=0.531, 0.626, and 0.627; all P<0.001). The ROC showed that serum TBil, D-dimer, and IL-6 had a certain value in evaluating the prognosis of elderly patients with sepsis [area under the curve (AUC) =0.790, 0.795, and 0.785; all P<0.001], and the combined evaluation value of the three items was higher (AUC=0.892, P<0.001). Conclusion　Detection of serum TBil, D-dimer, and IL-6 levels can effectively evaluate the condition of elderly patients with sepsis, and the combined detection of the three has a high evaluation value for the prognosis.

Key words: Total bilirubin, D-dimer, Interleukin-6, Elderly, Sepsis, Condition, Prognosis

摘要： 目的　探讨血清总胆红素（TBil）、D-二聚体及白细胞介素-6（IL-6）在老年脓毒症患者病情及预后评估中的价值。方法　回顾性分析2019年1月至2022年1月黄石市中心医院收治的166例老年脓毒症患者临床资料，其中男97例、女69例，年龄（75.5±4.0）岁，根据病情分为脓毒症组（134例）、脓毒性休克组（32例），另根据治疗28 d后的预后情况分为生存组（119例）、死亡组（47例）。比较不同病情及预后情况患者血清TBil、D-二聚体及IL-6水平，采用Spearman相关分析血清TBil、D-二聚体及IL-6水平与老年脓毒症患者病情的相关性，并采用受试者工作特征曲线（ROC）分析血清TBil、D-二聚体及IL-6水平对老年脓毒症患者预后的评估价值。计量资料行独立样本t检验。结果　脓毒性休克组血清TBil、D-二聚体、IL-6水平分别为（26.90±4.37）μmol/L、（4.86±1.14）mg/L、（276.25±24.33）pg/ml，均明显高于脓毒症组（19.85±3.83）μmol/L、（2.10±0.89）mg/L、（212.66±22.79）pg/ml，差异均有统计学意义（均P<0.05）。死亡组血清TBil、D-二聚体、IL-6水平分别为（24.15±4.09）μmol/L、（3.66±1.05）mg/L、（245.33±22.72）pg/ml，均明显高于生存组（20.05±3.56）μmol/L、（2.23±0.67）mg/L、（221.36±20.91）pg/ml，差异均有统计学意义（均P<0.05）。Spearman相关分析显示，血清TBil、D-二聚体、IL-6水平与老年脓毒症患者病情均呈明显正相关（r=0.531、0.626、0.627，均P<0.001）。ROC显示，血清TBil、D-二聚体、IL-6对老年脓毒症患者预后具有一定评估价值［曲线下面积（AUC）=0.790、0.795、0.785，均P<0.001］，且三项联合评估价值较高（AUC=0.892，P<0.001）。结论　检测血清TBil、D-二聚体、IL-6水平可有效评估老年脓毒症患者病情，且三者联合检测时对患者预后具有较高评估价值。

关键词: 总胆红素, D-二聚体, 白细胞介素-6, 老年, 脓毒症, 病情, 预后