OASIS与SAPSⅡ评分对ICU脓毒症患者院内死亡的预测价值比较——基于MIMIC-Ⅳ数据库的资料分析  

Comparison of the predictive value of the Oxford acute severity of illness score and simplified acute physiology scoreⅡfor in-hospital mortality in intensive care unit patients with sepsis:an analysis based on MIMIC-Ⅳdatabase

作　　者：罗春 顾汉阳 金雨虹[3] 刘冰洋 Luo Chun;Gu Hanyang;Jin Yuhong;Liu Bingyang(Department of Endocrinology,Ningbo Medical Center Lihuili Hospital(Ningbo University Affiliated Lihuili Hospital),Ningbo 315040,Zhejiang,China;Hangzhou Medical College,Hangzhou 311399,Zhejiang,China;Department of Intensive Care Unit,Ningbo Medical Center Lihuili Hospital(Ningbo University Affiliated Lihuili Hospital),Ningbo 315040,Zhejiang,China)

机构地区：[1]宁波市医疗中心李惠利医院(宁波大学附属李惠利医院)内分泌科,浙江宁波315040 [2]杭州医学院,浙江杭州311399 [3]宁波市医疗中心李惠利医院(宁波大学附属李惠利医院)重症医学科,浙江宁波315040

出　　处：《中华危重病急救医学》2022年第4期352-356,共5页Chinese Critical Care Medicine

基　　金：浙江省卫生健康科技计划项目(2021KY305);浙江省宁波市自然科学基金(202003N4229)。

摘　　要：目的比较重症监护病房(ICU)脓毒症患者牛津急性疾病严重程度评分(OASIS)和简化急性生理学评分Ⅱ(SAPSⅡ)对院内死亡的预测价值。方法使用美国重症监护医学信息数据库Ⅳ0.4(MIMIC-Ⅳ0.4)中的数据进行回顾性队列研究。以脓毒症3.0诊断标准为筛选条件,提取数据库中有感染且入ICU 24 h内序贯器官衰竭评分(SOFA)≥2分的首次入院的ICU成人脓毒症患者的基本信息,包括性别、年龄,是否使用血管活性药物、镇静药物、机械通气、肾脏替代治疗,ICU住院时间,以及OASIS、SAPSⅡ评分等。以院内死亡为主要结局指标,绘制受试者工作特征曲线(ROC曲线),并计算ROC曲线下面积(AUC),比较OASIS与SAPSⅡ评分对预后的预测价值。结果共有11098例ICU成人脓毒症患者被纳入最终分析,其中院内死亡2320例,存活8778例,院内病死率为20.90%。与存活患者相比,院内死亡患者年龄更大〔岁:71(60,81)比67(56,78)〕,ICU住院时间更长〔d:6.95(3.39,13.07)比4.23(2.19,9.73)〕,使用血管活性药物、镇静药物、机械通气、肾脏替代治疗的比例更高〔血管活性药物:50.65%(1175/2320)比33.05%(2901/8778),镇静药物:58.53%(1358/2320)比48.41%(4249/8778),机械通气:89.57%(2078/2320)比81.66%(7168/8778),肾脏替代治疗:11.98%(278/2320)比6.57%(577/8778),均P<0.01〕,且院内死亡患者有更高的OASIS评分〔分:43(36,49)比35(29,41),P<0.01〕和SAPSⅡ评分〔分:49(40,60)比38(31,47),P<0.01〕。ROC曲线分析显示,OASIS与SAPSⅡ评分预测ICU成人脓毒症患者院内死亡的AUC分别为0.713〔95%可信区间(95%CI)为0.701~0.725〕和0.716(95%CI为0.704~0.728),Delong检验显示二者的AUC比较差异无统计学意义(P>0.05)。结论OASIS评分对脓毒症患者院内死亡具有良好的预测价值,且与SAPSⅡ评分的预测能力相仿,说明比SAPSⅡ评分更加简便的OASIS评分有更广阔的临床应用前景。Objective To compare the predictive value of Oxford acute severity of illness score(OASIS)and simplified acute physiology scoreⅡ(SAPSⅡ)for in-hospital mortality in intensive care unit(ICU)patients with sepsis.Methods A retrospective cohort study was conducted using the data in the Medical Information Mart for Intensive Care-Ⅳ0.4(MIMIC-Ⅳ0.4).Based on Sepsis-3 diagnostic criteria,the basic information of ICU adult sepsis patients with infection and sequential organ failure assessment(SOFA)score≥2 within 24 hours of ICU admission admitted for the first time in the database was extracted,including gender,age,vasopressor drugs,sedative drugs,mechanical ventilation,renal replacement therapy,length of ICU stay,OASIS,SAPSⅡscores,etc.The primary outcome was in-hospital mortality.A receiver operator characteristic curve(ROC curve)was drawn,and the area under the ROC curve(AUC)was calculated to compare the prognostic value of OASIS score and SAPSⅡscore.Results A total of 11098 adult ICU sepsis patients were enrolled in the final analysis,of which 2320 died and 8778 survived in hospital,with a mortality of 20.90%.Compared with the survivors,the non-survivors were older[years old:71(60,81)vs.67(56,78)],had longer length of ICU stay[days:6.95(3.39,13.07)vs.4.23(2.19,9.73)]and higher proportions of using vasopressor drugs,sedative drugs,mechanical ventilation and renal replacement therapy[vasopressor drugs:50.65%(1175/2320)vs.33.05%(2901/8778),sedative drugs:58.53%(1358/2320)vs.48.41%(4249/8778),mechanical ventilation:89.57%(2078/2320)vs.81.66%(7168/8778),renal replacement therapy:11.98%(278/2320)vs.6.57%(577/8778),all P<0.01].Moreover,the non-survivors had higher OASIS score[43(36,49)vs.35(29,41),P<0.01]and SAPSⅡscore[49(40,60)vs.38(31,47),P<0.01]as compared with the survivors.ROC curve analysis showed that the AUC of OASIS score and SAPSⅡscore for predicting in-hospital death of ICU patients with sepsis was 0.713[95%confidence interval(95%CI)was 0.701-0.725]and 0.716(95%CI was 0.704-0.728),respectively,and t

关 键 词：脓毒症 牛津急性疾病严重程度评分 简化急性生理学评分Ⅱ 院内病死率 

分 类 号：R459.7[医药卫生—急诊医学]