简化急性生理评分Ⅱ与牛津急性疾病严重程度评分对重症监护病房患者短期预后的预测价值比较  

Comparison of predicitive value of SAPS Ⅱ and OASIS scoring systems in ICU patients' short-term outcomes

作　　者：陈钦桂 何婉媚[1] 郑海崇 张莉珊 曾勉[1] Chen Qingui;He Wanmei;Zheng Haichong;Zhang Lishan;Zeng Mian(Department of Medical Intensive Care Unit,First Affliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院MICU,广州510080

出　　处：《中华重症医学电子杂志》2018年第2期159-163,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：国家自然科学基金资助项目(81670066);广东省省级科技计划项目(2016A020216009);2017年贝朗蛇牌学院重症科学研究基金资助项目

摘　　要：目的比较简化急性生理评分(SAPS)Ⅱ与牛津急性疾病严重程度评分(OASIS)对重症监护病房(ICU)患者短期预后预测价值的差异,以期为实际临床工作中疾病严重程度评分系统的选择提供一定的研究证据。方法从美国重症监护数据库(MIMIC-Ⅲ)(2001年至2012年)提取成年(年龄≥18岁)ICU患者的基本信息、生命体征以及相关实验室检验指标等,按各评分系统的要求分别计算SAPSⅡ与OASIS评分,以ICU内病死为首要结局指标,绘制接受者操作特征(ROC)曲线,计算并比较曲线下面积(AUC)的差异。结果共有38 468例ICU成年患者被纳入最终分析,其中男性患者占56.61%,年龄中位数为65.72岁,ICU病死率为8.28%(3185/38 468)。与存活患者相比,ICU死亡患者具有更高的SAPSⅡ(存活者vs死亡者:32分vs51分,H=3473.792,P<0.001)与OASIS评分(存活者vs死亡者:30分vs 41分,H=3422.382,P<0.001)以及更高的机械通气比例(存活者vs死亡者:22.76%vs 73.59%,χ~2=3831.865,P<0.001)。ROC曲线分析显示,SAPSⅡ评分与OASIS评分的AUC分别为0.8147(95%CI:0.8068～0.8226)和0.8123(95%CI:0.8042～0.8204),Hanley-McNeil检验显示二者AUC差异无统计学意义(Z=0.686,P=0.4928)。结论 SAPSⅡ评分与OASIS评分对成年ICU患者短期预后的预测价值并无显著差异,更加简便的OASIS评分有望成为ICU疾病严重程度评分的另一选择。Objective To compare the predictive value of the simplified acute physiology score（SAPS） Ⅱ and the Oxford acute severity of illness score（OASIS） for short-term outcomes of patients in ICU and to provide evidence for selection of disease severity scoring system in clinical practice. Methods Data including baseline information, vital signs, and some laboratory test results of adult（age ≥18 years） ICU patients between January 2001 to December 2012 were extracted from a freely accessible critical care database（MIMIC-Ⅲ） and SAPS Ⅱ and OASIS scores of each patients were calculated according to the requirements of each scoring system. ICU mortality was our primary outcome and receiver operating characteristic（ROC） analysis was performed to determine the predictive performance by comparing the areas under ROC curves（AUC）. Results A total of 38 468 ICU adult patients were included finally, of which male patients accounted for 56.61% with a median age of 65.72 years old and an ICU mortality rate of 8.28%（3185/38468）. When compared with the survivors, non-survivors had higher SAPS Ⅱ（survivors vs non-survivors 32 vs 51, H=3473.792, P〈0.001） and OASIS scores（survivors vs non-survivors 30 vs41, H=3422.382, P〈0.001） and higher rates of mechanical ventilation（survivors vs non-survivors 22.76%vs 73.59%, χ~2=3831.865, P〈0.001）. The ROC curve analysis showed that the AUC of SAPS Ⅱ score and OASIS score were 0.8147（95%CI 0.8068-0.8226） and 0.8123（95%CI 0.8042-0.8204）, respectively, but the Hanley-McNeil test showed no significant difference of AUC between the two scoring systems（Z=0.686,P=0.4928）. Conclusion There is no significant difference in the predictive value of OASIS scores and SAPS Ⅱ scores for short-term prognosis of adult ICU patients, suggesting that OASIS, a simpler scoring system, might be another option for disease severity scoreing in ICU.

关 键 词：简化急性生理评分 牛津急性疾病严重程度评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]