4种评分系统对脓毒症患者预后的评估价值：附311例回顾性分析  

Predictive value of four different scoring systems for septic patient＇s outcome： a retrospective analysis with 311 patients

作　　者：王盛标[1] 李涛[1] 李云峰[1] 张建文[1] 戴新贵[2] 

机构地区：[1]郴州市第一人民医院重症医学科,湖南郴州423000 [2]南方医科大学附属南方医院重症医学科,广东广州510515

出　　处：《中华危重病急救医学》2017年第2期133-138,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金青年项目（81500066）

摘　　要：目的探讨急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、序贯器官衰竭评分（SOFA）、快速序贯器官衰竭评分（qSOFA）和全身炎症反应综合征（SIRS）评分4种评分系统在预测脓毒症患者死亡中的价值。方法回顾性分析2012年7月1日至2016年6月30日湖南省郴州市第一人民医院重症加强治疗病房（ICU）收治的脓毒症患者的临床资料，根据28 d预后将患者分为存活组和死亡组。比较两组患者一般资料，24 h内临床指标最差值，首日是否行机械通气，ICU住院时间，APACHE Ⅱ评分、SOFA评分、qSOFA评分和SIRS评分，并将单因素分析中差异有统计学意义的变量进行多元logistic回归分析；用受试者工作特征曲线（ROC）分析4种评分系统预测脓毒症预后的效能。结果最终纳入311例脓毒症患者，存活221例，28 d死亡90例，病死率为28.9%。单因素分析显示，两组间年龄、首日行机械通气比例、每日尿量、ICU住院时间和诊断脓毒症后24 h内心率（HR）、收缩压（SBP）、平均动脉压（MAP）、HCO3-、动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2）、吸入氧浓度（FiO2）、Na＋、尿素氮（BUN）、血肌酐（SCr）、血浆白蛋白（Alb）最差值及格拉斯哥昏迷评分（GSC）、APACHE Ⅱ评分、SOFA评分、qSOFA评分差异均有统计学意义（均P〈0.05）。多因素logistic回归分析显示，高龄〔优势比（OR）＝1.388，95%可信区间（95%CI）＝1.074～1.794，P＝0.012〕、低PaO2/FiO2（OR＝0.459，95%CI＝0.259～0.812，P＝0.007）、低Alb（OR＝0.523，95%CI＝0.303～0.903，P＝0.020）、低GCS评分（OR＝0.541，95%CI＝0.303～0.967，P＝0.038）、高SOFA评分（OR＝3.189，95%CI＝1.813～5.610，P＝0.000）是脓毒症预后的独立危险因素。ROC曲线分析显示，APACHEⅡ、SOFA、qSOFA评分均能预测脓毒症预后，其中SOFA评分的预测效能最强，ROC曲线下面积（AUC）为0.700�ObjectiveTo study the predicting value of four different scoring systems such as the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score, sequential organ failure assessment （SOFA） score, quick SOFA （qSOFA） score and systemic inflammatory response syndrome （SIRS） score for the prognosis of septic patients.MethodsA retrospective analysis were conducted. Septic patients in intensive care unit （ICU） of the First People＇s Hospital of Chenzhou form July 1st, 2012 to June 30th, 2016 were enrolled. Patients were divided into survival group and death group according to 28-day outcome. The difference of clinic data, the worst clinical index value within 24 hours, whether mechanical ventilation performed on first day, length of stay in ICU, APACHE Ⅱ score, SOFA score, qSOFA score and SIRS score were compared between the two groups. The significant different factors of sepsis outcome in univariate analysis were analyzed by multiple logistic regression, and the ability of four scoring systems was tested by receiver operating characteristic （ROC） curve.Results311 patients were enrolled in this study （221 survivals, 90 deaths, 28-day mortality rate 28.9%）. Univariate analysis showed age, mechanical ventilation ratio, urine output, length of stay in ICU and the fastest heart beat rate （HR）, the lowest systolic blood pressure （SBP）, the lowest mean arterial pressure （MAP）, HCO3-, minimum arterial blood oxygen partial pressure （PaO2）, minimum oxygenation index （PaO2/FiO2）, the maximum fraction of inspired oxygen （FiO2）, Na＋, the highest concentration of blood urea nitrogen （BUN）, the highest concentration of serum creatinine （SCr）, minimum concentration of plasma albumin （Alb）, Glasgow coma score （GCS） score, APACHE Ⅱ score, SOFA score, qSOFA score, within 24 hours after diagnosis were significantly different between two groups （all P 〈 0.05）. Multiple logistic regression showed age [odds ratio （OR） = 1.388, 95% confidence inte

关 键 词：脓毒症 序贯器官衰竭评分 快速序贯器官衰竭评分 急性生理学与慢性健康状况评分系统Ⅱ 全身炎症反应综合征评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]