8类重症评分预测ICU心脏骤停患者28 d死亡风险的预测价值  

Predictive value of 8-category severity scores in predicting 28-day mortality risk in ICU cardiac arrest patients

作　　者：李祥 邢家瑜 杜欣欣[1] 王毅[1] 于湘友[1] 杨春波[1] Li Xiang;Xing Jia-yu;Du Xin-xin;Wang Yi;Yu Xiang-you;Yang Chun-bo(Critical Medicine Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院重症医学科,新疆乌鲁木齐830054

出　　处：《中国急救医学》2022年第11期929-936,共8页Chinese Journal of Critical Care Medicine

基　　金：新疆维吾尔自治区自然科学基金(2021D01C305);国家自然科学基金(82160360);新疆维吾尔自治区科技支疆项目(2021E02064)。

摘　　要：目的探讨入住重症监护病房(ICU)心脏骤停(CA)患者的基本特征及入ICU首日8类重症患者疾病严重程度常用评分对28 d死亡风险的预测价值。方法提取美国重症监护医学信息数据库Ⅳ2.0(MIMIC-Ⅳ2.0)中2008至2019年重症患者的一般资料、疾病严重程度评分[急性生理学评分Ⅲ(APSⅢ)、牛津急性疾病严重程度评分(OASIS)、查尔森合并症指数(CCI)、Logistic器官功能障碍评分(LODS)、简化急性生理学评分Ⅱ(SAPSⅡ)、全身炎症反应综合征(SIRS)评分、序贯器官衰竭评分(SOFA)、终末期肝病模型评分系统(MELD)]及预后等指标。绘制8类重症评分预测患者28 d死亡风险的受试者工作特征(ROC)曲线,并计算ROC曲线下面积(AUC),使用最大约登指数定义最佳临界值,采用Delong法对各类评分的AUC进行两两验证。结果本研究共纳入2376例患者,其中生存组875例,早期死亡(28 d内)组873例,晚期死亡(>28 d)组628例。早期[70.75(57.63,81.83)岁]及晚期死亡组[70.10(60.32,79.30)岁]年龄明显高于生存组[63.67(52.88,72.90)岁],差异有统计学意义(均P<0.05),但两组差异无统计学意义(P>0.05)。三组第1天内实验室指标如血肌酐、尿素氮、血白细胞计数、国际标准化比值(INR)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、肌酸激酶同工酶(CK-MB)、碱性磷酸酶(ALP)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、乳酸脱氢酶(LDH)及血乳酸(Lac)差异均有统计学意义(均P<0.05);但晚期死亡组APTT、LDH、血Lac与生存组差异无统计学意义(P>0.05)。三组心力衰竭史、脑血管疾病史、糖尿病有并发症、糖尿病无并发症、轻度肝脏疾病史、重度肝脏疾病史、肾脏疾病史、恶性肿瘤史、急性肾衰竭及脓毒症差异有统计学意义(均P<0.05)。生存组与晚期死亡组心力衰竭史、脑血管疾病史、轻度肝脏疾病史及脓毒症差异无统计学意义(P>0.05)。生存组、�Objective To investigate the basic characteristics of patients with cardiac arrest(CA)admitted to the intensive care unit(ICU)and the predictive value of 8-category severity scores in the 28-day mortality risk of critically ill patients on the first day of ICU admission.Methods The general data,disease severity scores[acute physiology scoreⅢ(APSⅢ),Oxford acute severity of illness score(OASIS),Charlson comorbidity index(CCI),Logistic organ dysfunction score(LODS),simplified acute physiology scoreⅡ(SAPSⅡ),systemic inflammatory response syndrome(SIRS)score,sequential organ failure assessment score(SOFA),model for end-stage liver disease(MELD)]and prognosis indicators of critically ill patients from 2008 to 2019 in the medical information mart for intensive careⅣ2.0(MIMIC-Ⅳ2.0)were extracted.The receiver operating characteristic(ROC)curve of 8 types of critical illness scores predicting the risk of death at 28 days was drawn,and the area under the ROC curve(AUC)was calculated.The maximum Youden index was used to define the best critical value.Delong method was used to verify the AUC of various severity scores in pairs.Results A total of 2376 patients were included in this study,including 875 in the survival group,873 in the early death(within 28 days)group,and 628 in the late death(>28 days)group.The age of the early group[70.75(57.63,81.83)years]and the late death group[70.10(60.32,79.30)years]was significantly higher than that of the survival group[63.67(52.88,72.90)years],and the difference was statistically significant(all P<0.05),but there was no significant difference between the early death group and the late death group(P>0.05).Laboratory indicators in three groups such as creatinine,blood urea nitrogen,white blood cells,international normalized ratio(INR),plasma prothrombin time(PT),activated partial thromboplastin time(APTT),creatine kinase isoenzyme(CK-MB),alkaline phosphatase(ALP),aspartate aminotransferase(AST),alanine aminotransferase(ALT),lactate dehydrogenase enzyme(LDH)and lactate(Lac)wit

关 键 词：美国重症监护医学信息数据库(MIMIC) 心脏骤停(CA) 急性生理学评分系统Ⅲ(APSⅢ) 简化急性生理学评分Ⅱ(SAPSⅡ) 牛津急性疾病严重程度评分(OASIS) 查尔森合并症指数(CCI) Logistic器官功能障碍评分(LODS) 全身炎症反应综合征(SIRS)评分 序贯器官衰竭评分(SOFA) 终末期肝病模型评分系统(MELD) 28 d预后 

分 类 号：R459.7[医药卫生—急诊医学]