查尔森合并症指数联合序贯器官衰竭评分预测脓毒症患者的死亡风险  

Combination of Weighted index of comorbidities and sepsis-related organ failure assessment score in deathrisk evaluation of septic patients

作　　者：崔云亮[1] 李雨[1] 张树柳[1] 李慧丽[1] 陈德昌[2] 林兆奋[2] 田昭涛[1] 

机构地区：[1]济南军区总医院重症医学科,山东250031 [2]第二军医大学附属长征医院急救科,上海200003

出　　处：《中华危重病急救医学》2014年第1期41-45,共5页Chinese Critical Care Medicine

基　　金：基金项目：国家自然科学基金（81173402）

摘　　要：目的应用查尔森合并症指数（wIc）联合序贯器官衰竭评分（SOFA）预测重症监护病房（ICU）内脓毒症患者28d死亡的风险。方法回顾性分析2011年10月至2013年2月人住上海长征医院急救科ICU和济南军区总医院重症医学科的成年严重脓毒症／脓毒性休克患者的临床资料。记录其致病因素、既往病史、是否为严重脓毒症；计算入院时年龄评分和WIC评分、人院后24h内急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和SOFA评分。采用单因素和多因素logistic回归分析，并绘制受试者工作特征曲线（ROC曲线）预测患者的预后。结果共310例患者入组，存活223例（71．9％），死亡87例（28．1％）。单因素分析显示，死亡组与存活组的年龄评分、WIC评分、APACHE1I评分、SOFA评分、慢性心功能不全、2型糖尿病、脑血管疾病、肿瘤、多发伤、肺部感染、是否为严重脓毒症11个变量均P〈0．2。将上述11个变量纳入多因素logistic回归方程1并保存方程的预测概率，分析显示：年龄评分[优势比（OR）=1．228，95％可信区间（95％CI）为1．027．1．468，P=0．024]、wIC评分（OR=1．441，95％CI为1．067—1．947，P=0．017）、APACHEII评分（OR=1．090，95％CI为1．021-1．164，P=0．010）、SOFA评分（OR=1．308，95％CI为1．158—1．478，P=0．000）、是否为严重脓毒症（OR=O．206，95％CI为0．100—0．424，P=0．000）5个变量与脓毒症患者28d预后独立相关，其影响力由大到小依次为SOFA评分（wa18=18．554）、是否为严重脓毒症（Wats=18．369）、APACHE11评分（Wals=6．725）、WIC评分（Wals=5．662）、年龄评分（Wals=5．067）。将年龄评分、WIC评分、SOFA评分3个变量纳入多因素logistic回归方程2并保存方程的预测概率，分析显示：年龄评分（OR=1．330，95％CI为1．145。1．546，P=0．000）、wIC评分（OR：1．496，95％CI为1．145～1．546Objective To predict the risk of 28-day mortality in septic patients in intensive care unit （ICU） with the combination of Weighted index of comorbidities （WIC） and sepsis-related organ failure assessment （SOFA） score. Methods The clinical data of adult severe sepsis/septic shock patients in Department of Emergency Medicine of Changzheng Hospital and Department of Critical Care Medicine of Jinan Military General Hospital from October 2011 to February 2013 were analyzed retrospectively. The etiological factor, past history, having severe sepsis or not were recorded. Age score, WIC score, acute physiology and chronic health evaluation II （APACHE II ） score and SOFA score were calculated at or 24 hours after admission. The logistic regression was used and the receiver operating characteristic curve （ROC curve） was drawn to calculate the patients＇ outcome. Results In 310 enrolled patients, 223 （71.9%） patients survived and 87 （28.1%） died. Univariate analysis showed that the P values of the age score, WIC score, APACHE II score and SOFA score, chronic cardiac insufficiency, type 2 diabetes, cerebrovascular disease, tumor, multiple injury, pulmonary infection and having severe sepsis or not were all less than 0.2. The above Ⅱvariables were put into the multivariate logistic regression equation 1, of which predicted probability was reserved. It revealed that 5 variables were independently associated with 28-day prognosis, of which influence power in descendingorder were SOFA score （odds ratio （OR） =1.308, 95% confidence interval （95%CI）： 1.158-1.478, P=0.0003, having severe sepsis or not （OR=0.206, 95%CI： 0.100-0.424, P=0.000）, APACHE Ⅱ score （OR=l.090, 95%CI： 1.021-1.164, P=0.010）, WIC score （OR=1.441, 95%C/： 1.067-1.947, P=0.017）, age score （OR= 1.228, 95%CI： 1.027-1.468, P=0.024）, the Walswere 18.554, 18.369, 6.725, 5.662, 5.067, respectively. The 3 variables, age score, WIC score and SOFA score, were brought into the multivariate logistic regressi

关 键 词：查尔森合并症指数 急性生理学与慢性健康状况评分系统Ⅱ 序贯器官衰竭评分 脓毒 症 预后 

分 类 号：R459.7[医药卫生—急诊医学]