基于PIRO概念的模型对危重病患者预后的评估价值  

Value of a model based on PIRO conception in predicting the prognosis in critical patients

作　　者：王涛[1] 崔云亮[2] 褚志祥 刘杰[1] 班雨[3] 黎檀实[3] 

机构地区：[1]解放军总医院海南分院急救部,三亚572000 [2]济南军区总医院ICU,山东250000 [3]解放军总医院急诊科,北京100853

出　　处：《中华危重病急救医学》2013年第12期729-733,共5页Chinese Critical Care Medicine

基　　金：卫生公益性行业科研专项子课题（201002014）

摘　　要：目的探讨基于PIRO概念的多因素模型评估危重病患者预后的价值。方法回顾性分析2011年12月至2013年8月入住解放军总医院海南分院成年危重病患者的临床资料，根据28d预后分为死亡组和存活组，比较两组易感因素（predisposition，P）、损伤因素或致病因子（injury，Ⅰ）、机体对致病因子的反应（response，R）、致病因素造成的器官功能障碍（organ failure，O）等指标。将单因素分析有统计学意义（P〈0．2）的指标纳入多因素logistic回归分析，并绘制受试者工作特征曲线（ROC曲线），评价建立基于PIRO模型对预后的诊断价值。结果共有187例危重病患者纳人研究，死亡75例（占40．1％）。单因素分析显示：年龄、基础疾病评分、既往合并心脏疾病、糖尿病、脑血管疾病、血流感染、是否合并急性呼吸窘迫综合征（ARDS）、严重脓毒症／感染性休克、降钙素原（PCT）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）、急性病理生理评分（APS）、序贯器官衰竭评分（SOFA）等是影响预后的因素（均P〈0．2）；多因素logistic回归分析显示：基础疾病评分（优势比（OR）=1．874，95％可信区间（95％CI）1．138—3．084，P=0．014]、是否严重脓毒症，感染性休克（OR=0．167，95％CI 0．064—0．435，P=0．000）和SOFA评分（OR=1．498，95％CI 1．283～1．750，P=0．000）是影响预后的独立危险因素。联合上述因素较其他单因素能更好地判断预后，ROC曲线下面积（AUC）：基于单因素分析有统计学意义的指标构建的PIRO模型为0．877（0．821—0．934），P=0．000；基于基础疾病评分、严重脓毒症／感染性休克、SOFA评分构建的PIRO模型为0．871（0．814．0．928），P=0．000；APACHEⅡ评分为0．781（0．711～0．850），P=0．000；SOFA评分为0．762（0．687—0．837），P=0．000；APS为0．726（0．647～0．805）�Objective To investigate the values of factors based on PIRO conception in predicting the prognosis of critical patients. Methods The clinical data of critical patients admitted to Hainan Branch of PLA General Hospital from December 2011 to August 2013 were retrospectively analyzed. The patients were randomly divided into non-survivors and survivors groups according to 28-day outcome. Predisposition （P）, injury （I）, response （R） and organ dysfunction induced by injury （O） were compared between two groups. The indexes with statistical significance （P〈0.2） by univariate analysis were included in muhivariate logistic regression analysis, and the receiver operating characteristic curve （ROC curve） was plotted to evaluate the values of factors based on PIRO conception in predicting the prognosis of critical patients. Results One hundred and eighty-seven critical patients were enrolled, and among them 75 （40.1%） patients died. Univariate analysis showed that the age, underlying disease scores, history of cardiovascular disease, diabetes mellitus, and cerebrovascular disease, positive blood culture, whether or not complicated with acute respiratory distress syndrome （ARDS） or severe sepsis/septic shock, procalcitonin （PCT）, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）, acute pathophysiology score （APS） and sequential organ failure assessment （SOFA） were found to be the factors related with the prognosis （all P〈0.2）. Multivariate logistic regression analysis showed that the underlying disease scores [odds ratio（OR）= 1.874, 95% confidence interval （95% CI） 1.138-3.084, P=0.014], whether patients occurrence of severe sepsis/septic shock （OR =0.167, 95% CI 0.064-0.435, P=0.000） and SOFA scores （OR=1.498, 95%CI 1.283-1.750, P=0.000） were independent factors for predicting 28-day mortality. The new model combined with above factors had more prognostic value in predicting the mortality than a single variable. The area under ROC curve �

关 键 词：危重病 脓毒症 脓毒症器官功能障碍评分 急性生理学与慢性健康状况评分 

分 类 号：R459.7[医药卫生—急诊医学]