Howell-PIRO模型对严重脓毒症和感染性休克患者预后的预测价值  

The values of Howell - PIRO model in predicting in - hospital mortality for patients with severe sepsis or septic shock

作　　者：王小倩[1] 张泓[1] 

机构地区：[1]安徽医科大学第一附属医院急诊科,安徽合肥230022

出　　处：《中国急救医学》2016年第1期43-47,共5页Chinese Journal of Critical Care Medicine

基　　金：基金项目：国家级临床重点专科建设项目经费资助

摘　　要：目的探讨Howell—PIRO模型对急诊重症监护室（emergencyintensivecareunit，EICU）严重脓毒症及感染性休克患者预后的预测价值。方法回顾性研究2012—06—2013—06入住安徽医科大学第一附属医院EICU严重脓毒症和感染性休克患者的临床资料，分别计算急性生理学与慢性健康状况评分（APACHE）Ⅱ、Howell—PIRO评分及序贯器官衰竭（SOFA）评分，并加以分析。以28d预后为观察事件，比较其受试者工作特征（ROC）曲线下面积（AUC）。结果纳入研究共123例患者，严重脓毒症组102例（83％），感染性休克组21例（17％）。两组Howell—PIRO评分[（16±3）分vs．（19±3）分]和SOFA评分[（7±3）分vs．（10±3）分]比较差异均有统计学意义（P〈0．05），APACHEⅡ评分比较差异无统计学意义[（20±8）分vs．（24±9）分，P=0．058]。根据28d预后绘制ROC曲线：Howell-PIRO评分AUC为0．816（95％C10．736～0．880），敏感度为81．40％，特异度为64．86％，最佳截断值为17，P〈0．0001；APACHEII评分AUC为0．703（95％C10．614～0．782），敏感度为88．37％，特异度为45．95％，最佳截断值为27，P=0．0001；SOFA评分AUC为0．802（95％C10．721～0．869），敏感度为68．60％，特异度为81．80％，最佳截断值为7，P〈0．0001；三者间两两比较差异均无统计学意义（P〉0．05）。根据28d预后将患者分为存活组（86例）及死亡组（37例），病死率30％，两组三个评分系统比较差异均有统计学意义（P〈0．05）。结论Howell—PIRO评分对EICU严重脓毒症和感染性休克患者预后有较好的预测价值，并且其敏感度优于SOFA评分，特异度优于APACHEn评分。Objective To investigate the values of the Howell - PIRO （predisposition, infection, response, organ dysfunction） model in predicting the in - hospital mortality of severe sepsis or septic shock patients in the Emergency Intensive Care Unit （EICU）. Methods Clinical data of patients admitted to EICU of the First Affiliated Hospital of Anhui Medical University from June 2012 to June 2013 were retrospectively researched. APACHE Ⅱ , Howell - PIRO and SOFA scores were respectively calculated from EICU data. Areas under the receiver operator characteristic （ROC） curves for 28 -day prognosis were compared. Results A total of 123 enrolled patients, severe sepsis group was 102 （83%）, septic shock group was 21 （17%）. Compared with the two groups ： there were significant differences in Howell - Pmo scores（ 16 ± 3 ） vs. （ 19 ± 3 ） and SOFA scores （7 ± 3 ） vs. （ 10 ± 3 ） （ P 〈 0.05 ）, but it was no obvious difference in APACHE lI scores（20 ＋ 8） vs. （24 ± 9） （ P = 0.058 ）. ROC curve drawing according to the prognosis of 28 - day ： the area under the curve of Howell - PIRO scores was 0.816（95% CI 0.736 to 0.880）, the sensitivity was 81.40%, specificity was 64.86% , the best cut- off values was 17（P 〈0.0001 ） ; the area under the curve of APACHE Ⅱ scores was 0. 703（95% CI 0. 614 to 0. 782） ,the sensitivity was 88.37%, specificity was 49.95% , the best cut -off values was 27 （P = 0. 0001 ） ;the area under the curve of SOFA scores was 0. 802 （95% CI 0. 721 to 0. 869 ）, the sensitivity was 68.60%, specificity was 81.80%, the best cut - off values was 7 （ P 〈 0. 0001 ） ; There were no obvious differences in pairwise comparisons of the three scores （ P 〉 0.05 ）. The patients was divided into surviving group （86 cases） and death group （37 cases） according to the 28 days＇ prognosis,thirty -seven （30%） patients died within 28 days of presentation; The three systems were significant differences in two groups of contrast �

关 键 词：严重脓毒症 感染性休克 Howell-PIRO评分 APACHE Ⅱ评分 SOFA评分 预后 

分 类 号：R392[医药卫生—免疫学]