四种评分系统对脓毒症患者ICU死亡风险的预测价值比较  

Comparison of four scoring systems for predicting ICU mortality in patients with sepsis

作　　者：胡畅 胡波[1] 李志峰[1] 杨晓[1] 宋慧敏 李建国[1] HU Chang;HU Bo;LI Zhifeng;YANG Xiao;SONG Huimin;LI Jianguo(Department of Critical Care Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院重症医学科,湖北武汉430071

出　　处：《南方医科大学学报》2020年第4期513-518,共6页Journal of Southern Medical University

基　　金：国家自然科学基金(210900023)。

摘　　要：目的评价序贯器官衰竭评分(SOFA)、简化急性生理评分(SAPS-Ⅱ)、牛津急性疾病严重程度评分(OASIS)、Logistic器官功能障碍系统(LODS)评分系统预测ICU脓毒症患者死亡风险的价值。方法通过MIMIC-Ⅲ数据库提取2001年至2012年共计2470例脓毒症患者的临床资料,收集入ICU首日内SOFA评分、SAPS-Ⅱ评分、OASIS评分以及LODS评分。根据患者ICU存活情况分为存活组和死亡组,分析比较两组间不同评分系统的差异性,计算4种评分系统ROC曲线下面积进行差异性分析,对脓毒症患者ICU死亡情况进行二项Logistic回归分析,以综合比较4种评分系统对脓毒症患者ICU死亡的预测价值。结果2470例脓毒症患者中ICU内存活1966例(79.6%),死亡504例(20.4%)。其中死亡组年龄、机械通气使用率、初始乳酸、肌酐、尿素氮、SOFA、SAPS-Ⅱ、OASIS和LODS评分明显高于存活组(P<0.05),体质量及血小板明显低于存活组(P<0.05)。SOFA评分、SAPS-Ⅱ评分、OASIS评分以及LODS评分的ROC曲线下AUC值分别为0.729(P<0.001),0.768(P<0.001),0.757(P<0.001), 0.739(P<0.001)。其中SAPS-Ⅱ评AUC值明显高于SOFA评分和LODS评分(Z=3.679,P<0.001;Z=3.698,P<0.001),SAPS-Ⅱ与OASIS评分无明显差异(Z=1.102,P=0.271);OASIS评分明显高于LODS评分(Z=2.172,P=0.030),但与SOFA评分无明显差异(Z=1.709,P=0.088)。按照是否合并脓毒性休克将患者分为两组,在单纯脓毒症组中,SAPS-Ⅱ评分预测患者死亡的AUC值明显高于其他3种评分,为0.769(0.743-0.793),在合并脓毒性休克组中,SAPS-Ⅱ与OASIS评分预测患者死亡的AUC值明显高于其他两种评分,分别为0.768(0.745-0.791)、0.762(0.738-0.785)。二项Logistic回归多因素分析后发现SOFA、SAPS-Ⅱ、OASIS评分系统均与脓毒症患者死亡相关(OR:1.08,95%CI:1.03-1.14,P=0.001;OR:1.04,95%CI:1.02-1.05,P<0.001;OR:1.04,95%CI:1.01-1.06,P=0.001),但LODS评分与脓毒症患者发生ICU死亡无明显关系(OR:0.96,95%CI:0.89-1.04,P=0.350)。结论 SOFObjective To evaluate the value of Sequential Organ Failure Assessment(SOFA), Simplified Acute Physiology Score Ⅱ(SAPS-Ⅱ), Oxford Acute Severity of Illness Score(OASIS) and Logistic Organ Dysfunction System(LODS) scoring systems for predicting ICU mortality in patients with sepsis. Methods We collected the data of a total of 2470 cases of sepsis recorded in the MIMIC-ⅡI database from 2001 to 2012 and retrieved the scores of SOFA, SAPS-Ⅱ, OASIS and LODS of the patients within the first day of ICU admission. We compared with the score between the survivors and the non-survivors and analyzed the differences in the area under the ROC curve(AUC) of the 4 scoring systems. Binomial logistic regression was performed to compare the predictive value of the 4 scoring systems for ICU mortality of the patients. Results In the 2470 patients with sepsis, 1966(79.6%) survived and 504(20.4%) died in the ICU. Compared with the survivors, the non-survivors had a significantly older mean age, higher proportion of patients receiving mechanical ventilation, and higher initial lactate level,creatinine, urea nitrogen, SOFA score, SAPS-Ⅱ score, OASIS score and LODS score(P<0.05) but with significantly lower body weight and platelet counts(P<0.05). The AUCs of the SOFA score, SAPS-Ⅱ score, OASIS score, and LODS score were 0.729(P<0.001), 0.768(P<0.001), 0.757(P<0.001), and 0.739(P<0.001), respectively. The AUC of SAPS-Ⅱ score was significantly higher than those of SOFA score(Z=3.679, P<0.001) and LODS score(Z=3.698, P<0.001) but was comparable with that of OASIS score(Z=1.102, P=0.271);the AUC of OASIS score was significantly higher than that of LODS score(Z=2.172, P=0.030) and comparable with that of SOFA score(Z=1.709, P=0.088). For predicting ICU mortality in patients without septic shock, the AUC of SAPS-Ⅱ score was 0.769(0.743-0.793), the highest among the 4 scoring systems;in patients with septic shock, the AUCs SAPS-Ⅱ score and OASIS score, 0.768(0.745-0.791) and 0.762(0.738-0.785), respectively, were significantl

关 键 词：脓毒症 序贯器官衰竭评分 简化急性生理评分 牛津急性疾病严重程度评分 Logistic器官功能障碍系统 

分 类 号：R459.7[医药卫生—急诊医学]