最高SOFA评分对G+/G-主要致病菌致脓毒症患者临床结局的预测  

Maximum sequential organ failure assessment score and average sequential organ failure assessment score for prediction of clinical outcomes in patients with sepsis caused by common Gram-positive/negative bacteria

作　　者：于明基 赵延辉 李雪婷 尤伟艳[1] 许航[1] 任珊[1] Yu Mingji;Zhao Yanhui;Li Xueting;You Weiyan;Xu Hang;Ren Shan(Department of Intensive Care Unit,the First Affiliated Hospital of Medical School,Shihezi University,Shihezi 832000,China;Department of Pain,Shihezi City People′s Hospital,Shihezi 832000,China)

机构地区：[1]石河子大学医学院第一附属医院重症医学一科,832000 [2]石河子市人民医院疼痛科,832000

出　　处：《中华重症医学电子杂志》2020年第1期71-76,共6页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：石河子大学高层次人才科研启动项目(RCZX201443);石河子大学医学院第一附属医院院级科研项目(BS2016092)。

摘　　要：目的 评价最高序贯脏器衰竭(SOFA)评分、平均SOFA评分用于革兰阳性(G+)/革兰阴性(G-)主要致病菌所致脓毒症患者临床结局预测的价值。方法 纳入石河子大学医学院第一附属医院急诊ICU、综合ICU 2016年10月至2017年7月收治的脓毒症患者,于入院时即刻留取血培养、痰培养,分离致病菌,将培养结果阳性患者按照病原学检测结果分为G+和G-致病菌2组。在入院时、24 h、48 h、72 h、4 d、5 d......出院/死亡时间点,采集患者呼吸系统(PO2/FiO2)、肝脏(总胆红素)、肾脏(肌酐)、心血管系统(平均动脉压)、血凝(血小板计数)、神经系统(GCS评分)指标,行SOFA评分,计算平均SOFA评分。结果 纳入脓毒症患者62例,其中女20例,男42例,平均年龄(65.79±14.17)岁。G^+组28例,G^-组34例。患者器官衰竭数目与最高SOFA评分明确相关(G^+组男性患者相关系数为0.927,G^-组女性患者相关系数为0.847,P <0.05;G-组男性患者关系数为0.719,P <0.01)。最高SOFA评分与患者死亡结局明确相关(G+组相关系数为0.480,G-组相关系数为0.621,P <0.01)。绘制受试者工作特征曲线(ROC),各组最高SOFA评分ROC的曲线下面积(AUC)均高于平均SOFA评分ROC的AUC。结论 最高SOFA评分与患者器官衰竭数目、患者死亡结局均相关,最高SOFA评分对于患者死亡结局的预测价值更大。Objective To evaluate the application value of maximum sequential organ failure assessment(SOFA)score and mean SOFA score for the prediction of clinical outcome in patients with sepsis caused by gram-positive/gram-major pathogens.Methods Patients diagnosed sepsis of emergency ICU and comprehensive ICU of our hospital,from Oct.2016 to Jul.2017 were included in our study.Blood culture and sputum culture were immediately taken at the time of admission,and the pathogenic bacteria were isolated.All patients were divided into Gram-negative bacteria(G^-)group and Gram-positive bacteria(G^+)group and G-pathogenic bacteria(G^+)group according to the pathogen test results.PO2/FiO2(represented respiratory system function),total bilirubin(represented liver function),creatinine(represented kidney function),mean arterial pressure(represented circulation system function),platelet count(represented coagulation function),and GCS score(represented brain function)were collected at the time of admission,24 hours,48 hours,72 hours,4 days,5 days...after admission,until the patient died or out of hospital.Then,calculated maximum SOFA score and mean SOFA score.Results Totally 62 patients were enrolled,including 20 females and 42 males,with an average age of(65.79±14.17)years.There were 28 cases in the G+group and 34 cases in the G-group.The maximum SOFA score showed a clear correlation with the number of patient′s organ failure(G+male,correlation coefficient 0.927;G^+female,correlation coefficient 0.847,P<0.05;G^-male,correlation coefficient 0.719,P<0.01);the maximum SOFA score was significantly associated with the prognosis of death of patients(G^+correlation coefficient 0.480,G^-correlation coefficient 0.621,P<0.01);the maximum SOFA score showed the highest area under the ROC curve.Conclusions Maximum SOFA score was associated with the number of patient′s organ failure and the death outcome of patient.Maximum SOFA score also showed more significance value in evaluating prognosis.

关 键 词：SOFA评分 革兰阳性细菌 革兰阴性细菌 临床结局 

分 类 号：R459.7[医药卫生—急诊医学]